Distance Learning Enrolment Form

Course Title*

Please note, you can only apply for one Distance Learning course per application.

Personal Details

Name*

Date of Birth*

Email Address*

Contact Number*

Address*

Sex*

Please note, The Government specifies the options we can collect for Sex.

Gender Identity

This is an optional question. We collect this so you can make us aware of your gender identity if you wish.

Preferred First Name

No Nicknames. Preferred first names are subject to approval and will only be used on your ID badge, registers, Microsoft Teams and email account

National Insurance Number*

Identification

ID Upload*

To confirm the details you have previously submitted, please upload an image (jpg,png,pdf, maximum size of 128mb) of one of the following; passport, birth certificate, photo driving licence or national ID card

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 10 MB.

Ethnic Origin and Residency

What is your ethnicity*

What is your country of nationality*

Have you lived in England for the last 3 years?*

Which country(ies) you have been living in?

What is your EU Settlement Status?

For EU, EEA or Swiss citizens only

Date Received

Settlement Status Share Code

Underrepresented Groups

Please enter details of any categories you belong to (leave blank if you prefer not to say). This data helps us to support and prioritise underrepresented groups. This will be used internally only and will not be used to identify individuals.

Are you a Care Leaver? (an adult aged 18-25 who has spent time in care)

Are you a Carer? (Looks after family, friend, partner due to illness, disability etc)

Are you estranged from your family? (Loss of previously existing relationship)

Are you a Refugee? (Fled home country due to fear of persecution)

Are you a Gypsy, Roma or Traveller? (Has nomadic way of life)

Have either of your parents/carers served in the UK Armed Forces (RAF, Army etc)?

If enrolling on a Higher Education course, are you the first person in your immediate family to study at HE level?

Learning Difficulties/Disabilities/Health Problems

Do you have a learning difficulty, disability or health problem?*

If yes, please select from the list below

Which of these do you consider to be your main difficulity/disability?

Please state the number from the above list.

Qualifications

What is your highest qualification?*

Please state...

Please state the full title of your highest qualification

Education

Were you in full time education or training prior to applying for this course?*

Have you studied at Boston College previously?*

Are you enrolled at any other provider?*

Employment

What is your current employment status?*

How long have you been in your current employment?

How many hours do you work per week (on average)?

Do you earn less than £20,319 annual gross salary?

Length of unemployment?

Which benefits are you in receipt of?*

None
Job Seekers Allowance
Employment Support Allowance (work related)
Universal Credit
Other

Please state...

Do you earn less than £338 a month (as an individual) OR £541 a month (as a joint claim)

Criminal Convictions

Boston College is keen to support all learners and to help them succeed. Having criminal convictions will not necessarily prevent you from taking up a place.

Do you have any unspent or pending criminal convictions?*

Please note that if you are applying for a Health and Social Care or Early Years course, you need to disclose all criminal convictions, cautions or warnings.

A member of the College will be in contact for further details

If you do not select either option, your application will not be processed.

If you are convicted of a criminal offence while your course is in progress, you must notify the Learner Services Department immediately. Boston College collect this data in order to protect the vital interests of others and to carry out our duty to support those with a conviction.

Emergency Contact Details

These details will be used in case of an emergency. They will not be used for any other reason.

Emergency Contact Name*

Emergency Contact Telephone Number*

Emergency Contact Relationship*

Boston College may contact you...

The English European Social Fund (ESF) Managing Authority (or agents acting on its behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training.

Please tick if you agree to be contacted for other purposes

About courses or learning opportunities
For surveys and research

Contacted by...

Post
Telephone
Email

How did you hear about Distance Learning at Boston College

Name of Employer

Privacy Statement

The information you have provided on the above form will be used to process your application for the course you are applying for. For more information on how your personal data will be used, please read our Privacy Policy.

Declaration/Learning Agreement

Before submitting this enrolment form, please read of the terms of enrolment within our Declaration/Learning Agreement.

Confirmation

By ticking the box and typing your full name below, you are confirming the following statements:

All of the above inputted information is correct. I agree to inform the College of any change of circumstances regarding details given on this form.
You understand and agree to all of the above terms and conditions within the Declaration/Learning Agreement and Privacy Policy.
You have fully read the information about this course and specifically how the course is assessed.
You are aware of the time commitment and assessment criteria and can commit to these requirements.
You are aware of the £85 non-completion fee for which you are liable for if you withdrawn or do not complete the course

I confirm and agree to the above statements

Course Enrolment

Course Enrolment Form