Annex P
Participant exit form (London only)
For participants and project staff to complete /

This form must be completed before the participant leaves the project.

These details will be stored securely and retained at least until 31 December 2026, in compliance with the Data Protection Act 1998. This information will be used to evaluate this project and to report to the Big Lottery Fund and European Social Fund for monitoring purposes. You may be contacted to discuss your involvement in the project.

For the purposes of the Data Protection Act 1998, the Department for Work and Pensions is the data controller in respect of information processed which relates to your participation in the project funded by the European Social Fund, whilst the Big Lottery Fund is the data processor.

Part one: Summary

This is completed by project staff once the participant’s eligibility has been confirmed.

Organisation:
Participant name:
National Insurance number:
Customer reference number:
Leavingdate from project:
This is the date of their last activity on the project

Part two: Participant results on exit from the project

Only to be completed by participants who were economically inactive on joining:

You are engaged in further education or training

If you ticked the education box above, you can also tick one of the following boxes (if applicable) since they count as separate results:

You’ve moved into job-searching

You’ve moved into employment (including self-employment)

Only to be completed by participants who were unemployed on joining:

You are engaged in further education or training

You’ve moved into employment (including self-employment)

If you have ticked any of the above options in section 2 please provide more details in the following sections. If you have not, please skip to section six.

Part three: Education or training

If you’ve moved into further education or training, we need you to provide a letter or document from the school, college, university or learning provider demonstrating that you have formally registered and started. We must see an original and we will make a photocopy for our own records.

Tell us more about what you are doing here:

Part four: Employment or self-employment

If you’ve moved into employment, we need you to provide either:

a letter or document from the employer confirming that you have started a new job or

a payslip or

a signed contract of employment.

If you’ve moved into self-employment, we need you to provide either:

aletter or document showing that your business activity is registered with HMRC for tax, VAT or National Insurance purposes or

a record showing that your business activity is active and operating, such as a bank statement or a lease/purchase agreement on equipment and premisesor

if registered with Companies House, a record listingyou as a company director.

We must see an original and we will make a photocopy for our own records.

Tell us more about what you are doing here:

Part five: Job-search

If you’ve moved into job-searching, we need you to provide either:

a CV and a list of jobs applied foror

a letter or document from Jobcentre Plus or the Department for Work and Pensions that confirms you are registered as unemployed or

a letter or document from a government agency showing that you have newly engaged with mainstream support and you are working with them to apply for jobsor

a bank statement showing benefit payments.

We must see an original and we will make a photocopy for our own records.

Tell us more about what you are doing here:

Part six: Your employment status

What is your current employment status?

Inactive (including not in education or training)

Unemployed (including long-term unemployed)

Employed (including self-employed)

NOTE: Although not required on this form, the lead organisation must have a mechanism in place to record the period of sustained employment achieved by the participant (set at 26 out of 32 weeks after entering employment) and the continued support offered during that time (six months) as evidence of meeting this sustained employment project result.

Part seven: Satisfaction(Projects should collect and collate these findings over time as they are needed for GLA employment performance rating)

1.What do you think of the trainer or advisor you have been working with?

Very good / Good / Not good or bad / Bad / Very bad
Knowledge of the subject or activity.
Understanding of your needs.
Support in setting targets to help you achieve your goals.
Help with finding other support for you.
Support with helping you to plan your next steps.

2. How has this activity made a difference to you?

Improved a lot / Improved a little / Not changed / Got worse / Got much worse
My confidence has…
My skills have…
My prospects of getting a job have…
My knowledge of the options available to me has…
My motivation to make the next steps has…
My ability to manage my time and responsibilities has…

3. Overall how satisfied or dissatisfied were you with the activity?

Very satisfied / Satisfied / Neither satisfied or dissatisfied / Dissatisfied / Very dissatisfied

Part eight: Participant declaration

Tick each box to confirm:

The support I have received was funded by the European Social Fund and the Big Lottery Fund.
The information provided in the form is, to the best of my knowledge, accurate.
If I am newly engaged in job-searching, I confirm that this is true.
I give permission for your personal details to be shared with the Big Lottery Fund and other authorised bodies.
I understand that this information will be retained until at least 31 December 2026 for evaluation purposes.
I may be contacted at any time to discuss my involvement in the project.
Name: / Signature:
Date:

Part ten: Project officer declaration

Tick each box to confirm:

The participant has been told that the support they have received was funded by the European Social Fund and the Big Lottery Fund.
The information provided in the form is, to the best of my knowledge, accurate.
I have checked original evidence to demonstrate that the results listed have been achieved.
I understand that this form and the items of evidence provided must be retained until at least 31 December 2016.
I understand that the Big Lottery Fund, or other authorised bodies, may request to see this information at any time.
Name: / Signature:
Job title:
Organisation:
Date:

Annex P: Participant exit form(v7.0-23 May2017)