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Course and Applicant Details
Training Provider and ULN
Unique Learner Number (ULN)
Do you give permission to OMG to obtain you Unique Learner Number (ULN)
Yes
No
Course Applying For
Course Title
In2 Music & Events Management - Level 1
Applicant Details
Title
please choose an option
Mr
Miss
Mrs
Ms
Mx
Other
Learner First Name
Learner Middle Name
Learner Surname
Preferred Given Name
Other Previous Name
National Insurance Number
Home Address
Postcode
Personal Email Address
Do you consent to your details being saved and added to our mailing list?
Yes
No
Mobile Telephone Number
Date of Birth
Place of Birth
Age Group
16-18
19-24 with an EHCP
Age on 31 August 2021
Gender
Male
Female
Other
Rather not say
If you identify as a different gender but have not legally changed your gender please state it here
If you have ticked any of the other boxes please give full details here
Nationality
Ethnicity (Please select one)
English, Welsh, Scottish, Northern Irish or British
White and Black Caribbean
Indian
Any other Asian background
Arab
Irish
White and Black African
Pakistani
African
Any other ethnic group
Gypsy or Irish Traveler
White and Asian
Bangladeshi
Any other Black / African or Caribbean background
Any other white background
Any other mixed or multiple ethnic background
Chinese
Caribbean
Prefer not to say
Do you have criminal convictions?
Yes
No
Emergency Contact 1
Emergency Contact 1 - Name
Emergency Contact 1 - Relation
Emergency Contact 1 - Address
Emergency Contact 1 - Telephone
Emergency Contact 2
Emergency Contact 2 - Name
Emergency Contact 2 - Relation
Emergency Contact 2 - Address
Emergency Contact 2 - Telephone
Methods of Communication
Please select all contact methods that we can use to communicate with you.
Telephone
Email
SMS/Text
Post
Identification and Residency Confirmation
Identification Type
As part of government funding requirements, we will require details of one form of ID
Full Driving licence
Provisional Driving licence
Passport
Birth Certificate
Other Acceptable Evidence (Residency Document, UK VISA etc)
Full/Provisional UK Driving Licence
Driving Licence Number
Country of Issue
Date of Issue
Date of Expiry
Passport
Passport Number
Country of Issue
Date of Issue
Date of Expiry
Birth certificate
Birth Certificate Number
Other Acceptable ID Evidence (state identity cards or residency permit/VISA)
ID Type
Issue Number
Issue Date
Expiry Date
Residency Confirmation
Which of the following statements apply
I am a UK Citizen and have been ordinarily resident in the UK or EEA (including other countries determined to be within the EEA or those with bilateral agreements) for at least the previous three years on the first day of the apprenticeship.
I am a citizen of a country within the European Economic Area (EEA) (including other countries determined within the EEA or those with bilateral agreements), or have the right of abode in the UK, and have been ordinarily resident in the EEA (including oth
I am a non-EEA citizen with permission from the UK government to live in the UK, (not for educational purposes) and have been ordinarily resident in the UK for at least the previous three years before the start of learning .
State Benefits
State Benefits
Are you in receipt of benefits?
Yes
No
Please select all state benefit(s) that you receive
Universal Credit
Job Seekers Allowance
Child Benefit
Income Support
Tax Credits
Other State Benefit
No State Benefit
Prior Qualifications and Assessment
Last School/Institute
What was the last school/institute you attended?
Prior Qualifications - Highest level English qualification
English Qualification Title (GCSE, A level, Functional skills)
English Qualification Level & Grade
English Qualification Date Attained
English Qualification Provisional Result
Yes
No
Prior Qualifications - Highest level Maths qualification
Math Qualification Title (GCSE, A level, Functional skills)
Math Qualification Level & Grade
Math Qualification Date Attained
Math Qualification Provisional Result
Yes
No
Equal Opportunities and Support Information
Equal Opportunities Monitoring
Learning Difficulties, Disabilities and Health Problems
I have a visual impairment
I have social and emotional difficulties
I have dyslexia
I have a temporary disability after illness (e.g. post viral) or accident
I have another medical condition (e,g. epilepsy, asthma, diabetes)
I have a hearing impairment
I have mental health difficulties
I have dyscalculia
I have speech, language and communication needs
I have a learning difficulty non specific
I have a disability affecting mobility
I have a moderate learning difficulty
I have Autism spectrum disorder
I have another physical disability not stated here
I have another disability not stated here
I have profound complex disabilities
I have a severe learning difficulty
I have Asperger’s syndrome
I have another specific learning difficulty (e.g. Dyspraxia)
I prefer not to say
I have no learning difficulties
Having looked at the above question, please indicate which if any of the following apply to you
I believe I have a learning difficulty, disability or health problem
I do not consider myself to have a learning difficulty, disability or health problem
I prefer not to say
Do you have any other learning difficulties, disabilities that you would like to make us aware of
Support Information
Who are you living with?
What are your living arrangements?
Living with the parent/carer
Living independently
Living in a hostel
I am homeless
Are you currently living in foster care or have you recently left foster care?
Yes
No
If you have answered yes to the question above, please provide contact details of your social worker
Does your parents, carer or guardian have any of the following
An illness that will impact your learning
Disability
Mental ill health
Alcohol and substance misuse issues
None
Are you involved with YOT or have been previously ?
Yes
No
If you have ticked yes to the previous question, please give us the details of your YOT worker
Are you considered as a child in need (CIN) and/or do you have a Care plan (CP)
Yes
No
Do you receive free school meals?
Yes
No
Don't Know
Are you alone in this country?
Yes
No
Are you a parent?
Yes
No
Are you a young carer?
Yes
No
Do you need any support with regards to counselling or mentoring?
Yes
No
Do you have any of the following?
Social worker
Youth offending team worker
Or other key worker(s)
None
Household Status
Tick any one of the following statements that describe your household status? (or leave blank if the
No member of the household in which I live (including myself) is employed
The household that I live in includes only one adult (18 or over)
There are one or more dependent children (Aged 0-17 years or 18-24 years in full time education or inactive) in the household
None of these statements apply
I confirm I wish to withhold this information
Identification and Residency Documents
Identification and Residency Documents
UK Passport
Choose file
UK Driving Licence
Choose file
Birth Certificate
Choose file
Other Acceptable ID and Residency Document(s)
Choose file
Proof of Address
Choose file
Proof of Parents or Carer House Income
Choose file
Looked After Children (LAC) Document
Choose file
Other Supporting Document(s)
Choose file
Learner Declaration
Declaration
Learner Declaration
I confirm to the best of my knowledge that all information provided to OMG Education CIC is correct, and I will provide documentary evidence if required. I understand that my enrolment at OMG Education CIC may be terminated if I am found to have made false statements, omitted significant information or provided counterfeit or forged documents in my application to OMG Education CIC.
Date