Your Care & Support - Yeovil College

Do you have a medical condition, learning difficulty or disability that may affect your studies?If so, what do you require extra help with? (please tick)Writing Study Skills Spelling NumeracyMedical ConditionsOther Specific LearningDifficultiesYeovil College welcomes the Disability Discrimination Act (part 4) and we want to help you get the very best experience from your course.We will offer opportunities prior to enrolment for you to disclose and discuss (in private) your individual support needs. (If you fail to discloseinformation at this stage it may delay provision or relevant on-course support).Is English your first language? Yes NoPlease state your most recent School or College:School/College Name: Date from: Date to:School/College Address if not in Somerset or Dorset:Are you currently a Yeovil College Student?Yes NoIf yes please enter the name of your Tutor:Enrolment interviews will take place in June 2013.Autumn Term begins week commencing 2nd September 2013. Please state the dates of yourholidays if you are unable to attend the enrolment interviews in June 2013.How did you hear about Yeovil College?Careers Service/Connexions School Advert Yeovil College websiteInformation Event Friends/Family OtherFinancial assistance may be available if you are applying for a full-time course at college.For further information regarding Learning Support Funds, please contact the Learner,Finance and Welfare Co-ordinator on 01935 845452.The College reserves the right to withhold certification if any fees or charges remain outstanding at the end of the course.RETURN ADDRESS: Yeovil College, Mudford Road, FREEPOST (BS89450), Yeovil Somerset BA21 3TZThe personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”) and, when needed, the Department forEducation, 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 beshared with other partner organisations for purposes relating to education or training.Further information about use of and access to your personal data, and details of partner organisations are available at: http://skillsfundingagency.bis.gov.uk/privacy.htm, http://www.learningrecordsservice.org.uk/documentlibrary/documents/Code+of+Practice+for+Sharing+of+Personal+Information.htmTick this box if you do not wish to be contacted in respect of surveys and research.Acceptable methods of contact (if applicable):Tick this box if you do not wish to be contacted about courses or learning opportunities. Post Email TelephoneThe data you supply will be passed to Managing Information Across Partners (MIAP) service for the purpose of allocating you a Unique LearnerNumber (ULN) and creation of your Personal Learning Record. The ULN is used to enable collection and sharing of data within the educationsector. The Personal Learning Record will be a lifelong record of your learning and qualifications, which will be accessible to you, organisationslinked to your education and training and any other organisations you choose. For further details of how your data is shared and used by MIAPand how to change who has access to your record, please see the MIAP website at www.miap.gov.uk. Please familiarise yourself with the MIAPStandard Fair Processing Text, copies of which can be found at www.learningrecordsservice.org.uk/privacynotice and from the college.If there is anything else you would like to make us aware of please detail below:e.g. sport, musical interests, Duke of Edinburgh Award or community involvement.I confirm that all the information detailed on this form is correct.LearnerParent Guardian Signature:Signature: (if learner is under 18)