260-264 Kingsland Road

London E8 4DG

Tel. (020) 7275 6750

ELATT APPLICATION FORM
1)  PERSONAL DETAILS
Title / Mr □ Mrs □ Miss □ Ms □ Other □
Full Name
Address
Post Code
Date of Birth / Age
Home Number / Mobile Number
National Insurance No. /
Gender /
Male □ Female □
Length of time in UK/
Status / /
Languages
Spoken
/
Which London borough
do you live in? /
Hackney
/
Tower Hamlets
/
Islington
Newham
/
Waltham Forest
/
Camden
Other (please state) /

For office use only

RECORD OF CONTACT
Date / Notes / Staff Name

For office use only

ELIGIBILITY
I certify that I have seen the passport/documentation that demonstrates the eligibility of this learner and a copy was submitted by the candidate. Please record on last page.
Type of documentation seen and copy taken for learner file (please tick)

• Passport or Home Office document
• Current proof of benefits
• Spouses dependent- marriage cert
• Current proof of address
• Proof of 1 or 3 years residency in the EU (where applicable)
______
Staff Signature / Date
2)  ETHNICITY
White / White – British □ Gypsy / Irish Traveller □ Any other White background □
Black / Caribbean □ Black-African □ Any other Black background □
Asian / Bangladeshi □ Pakistani □ Indian □ Chinese □ Any other Asian background □
Mixed / White and Black African □ White and Asian □ Any other Mixed background □
Other / Arab □ Turkish / Kurdish □ Other □
3)  DISABILITY
Do you consider yourself to have a Disability or Health Problem? / Yes □ No □
If yes please specify:
Do you consider yourself to have a Learning Difficulty? / Yes □ No □
If yes please specify:
Do you think you may need additional support? / Yes □ No □
4)  FAITH
Muslim □ Christian □ Jewish □ Buddhist □ Hindu □ Sikh □ No beliefs □
Other □ If you selected “other” please specifiy:
5)  SEXUAL ORIENTATION
Heterosexual / Straight □ Bisexual □ Undecided □ Gay Man □ Gay Woman / Lesbian □
Other □ If you selected “other” please specifiy:
6)  MARITAL STATUS AND PARENTING
Single □ Married / Civil Partner □ Divorced □ Widowed □ Separated □
Single Parent □
Are you pregnant? / Yes □ No □
In the past year have you taken any of the following? / Maternity Leave □ Paternity Leave □
None of the above □
7)  BENEFIT STATUS
Job Seeker’s Allowance □ Income Support □ Refugee / Asylum Seeker □
Household Income under £16,190 □ Disability Living Allowance □ Council Tax □
Carer’s Allowance □ Pension Credit □ Housing Benefit □ Universal Credit □
Working / Child Tax Credit □ NASS □ Employment and Support Allowance □
Free School Meal □ None of the above □
8)  PREVIOUS EDUCATION
No Schooling □ Primary School □ Secondary School □
Higher Education Started □ College / Vocational Training □ Degree □
Post Graduate Study □
8a) PREVIOUS LEARNING IN UK
Yes □ No □ / Where / When / Qualifications / Reason for not attending
9)  WHAT WOULD YOU LIKE TO STUDY AT ELATT?
Web Design □ IT Systems Support □ Skills for the Office □ Introduction to Care □
Business Admin (Apprenticeship and Traineeship) □ English □ Maths □
9a) (FOR STUDENTS STUDYING ENGLISH ONLY) REASONS FOR LEARNING ENGLISH
To understand my children □ To deal with everyday life □ To be active with the community □
To help my children at school □ To become independent □ To get a job □
To go on to further education □ To make friends □ To get a better job □
Job centre requirement □ To improve Literacy □ Citizenship application □
Other reasons □
10) EMPLOYMENT STATUS
Please tick any of the following that apply to you
Employed
Please state how long you have been employed / Years / Months
Full Time, ______Hours per week □ Part Time, ______Hours per week □
Self-employed □ Zero hours □
Unemployed
Please state how long you have been unemployed / Years / Months
Looking for work and are available to start work □
Not looking for work and / or not available to start work □
10a) PREVIOUS WORK EXPERIENCE
Home Country
EU / UK
11) DO YOU HAVE CARING RESPONSIBILITIES
Yes □ No □ / If yes please select all that apply:
Primary carer for a child/children (under 18)
Primary carer for a child/children (under 18)
Primary carer for disabled adult (18+)
Primary carer for an old person (65+)
Secondary carer
12) CHILDCARE
Do you require childcare financial support? / Yes □ No □
Child 1 Date of Birth
Child 2 Date of Birth
13) ABILITY TO TRAVEL TO CLASS
Walking Distance □ Bus □ Train □
Do you require travel expenses? / Yes □ No □
14) HOW DID YOU HEAR ABOUT ELATT?
15) CLASS PREFERENCES
Morning □ Morning / Afternoon □ Evening – 6.00pm to 9.00pm □
16) WHAT COURSES ARE YOU ELIGIBLE FOR
Please tick all that apply to you / √ / Show your ID to the advisor
You are a British citizen
You are an European Union citizen / Please show passport or ID
You have indefinite leave to remain / Please show document
You are on Jobseekers Allowance or another
form of benefit. Please specify.
Are you on a Work programme? / Benefit type: ______
Please show proof of benefits
You are a refugee or family / dependent of a
refugee / Please show either your passport or a letter
from the Home Office, or Immigration and
National Defence (IND)
You are an asylum seeker / Please show your letter from the Home Office,
Immigration and National Defence (IND), or
NASS.
If none of these apply to you please ask an advisor for help
17) HOW WE WILL USE YOUR DATA
All provision:
'Data Protection Act 1998 - The information you provide on this form will be passed to the funders, who
are registered under this act primarily for the collection and analysis of statistical data. The funders will
collect and share this information with other organisations for the purpose of administration, careers and
other guidance, statistical and research purposes. This will enable the funders and partners to monitor
performance, improve quality and plan future provision. Some of our projects have been part-financed by
the European Union through the European Social Fund - helping develop employment by promoting
employability, business spirit and equal opportunities, and investing in Human Resources.
Skills Funding Agency funded provision:
The personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”)
and, when needed, the Department for Education, including the Education Funding Agency to meet legal
responsibilities under the Apprenticeships, Skills, Children and Learning Act 2009, and for the Agency’s
Learning Records Service (LRS) to create and maintain a unique learner number (ULN). The information
you provide may be shared with other organisations for education, training and employment–related
purposes, including for research. Further information about use of and access to your personal data, and
details of organisations with whom we regularly share data are available at:
http://skillsfundingagency.bis.gov.uk/privacy.htm
Please tick if you do not want the funder or other associated body to contact you for
information purposes. □
Learner Signature / Date