Online Application Form

    Basic Information

    Your Details

    If anyone has helped you complete this form, please give their details

    Placement details

    Privacy Notice How We Use Your Personal Information

    The personal information you provide is shared with the Education & Skills 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: www.gov.uk/government/organisations/education-and-skills-funding-agency.

    At no time will your personal information be passed to organisations for marketing or
    sales purposes. I agree that information gathered through the assessment process at
    Landmarks, including the taster day, and information supplied by other agencies and
    any associated reports can be shared with relevant staff at Landmarks, the appropriate funding authority and any other relevant organisations in support of the application for the potential learner.

    I agree that Landmarks can contact any of the people/agencies listed below to support them in the process of assessing the needs of a potential learner:

    • School/College - or other placement
    • Social Services
    • Futures/LDD Adviser/SEND Team
    • Psychology and/or Psychiatry
    • Speech & Language Therapy
    • Occupational Therapy
    • Physiotherapy
    • Others as applicable

    Your Information

    Your Information

    Address

    A bit about you

    Carer Details

    Professional & Agency Details

    School/College Contact

    Add +

    SEND or LDD Adviser Contact

    Add +

    Social Worker

    Add +

    Local Education Authority

    Learning Difficulty & Disabilities

    Primary learning difficulty and/or disability

    Additional learning difficulties and/or disabilities

    Medical Information

    Do you take any medication?

    Medication #1

    Add +

    How do you take your medication?

    Medication #2

    Add +

    How do you take your medication?

    Medication #3

    Add +

    How do you take your medication?

    Medication #4

    Add +

    How do you take your medication?

    Medication #5

    Add +

    How do you take your medication?

    Your GP

    Allergies

    Do you have a history of the following?

    Do you have Epilepsy?

    Please ensure a Care Plan for the Administration of Buccal Midazolam is attached.

    Diabetes
    High blood pressure
    Heart problems
    Mental Health Problems
    Anxiety/Depression
    Asthma
    Breathing Difficulties
    Hearing Difficulties
    Visual Difficulties
    Do you Smoke?

    Please indicate by ticking below which vaccinations have been given and the dates these were administered.

    Vaccination
    Given?
    Vaccination: Tetanus
    Vaccination: Diptheria
    Vaccination: Polio
    Vaccination: Hepatitis B
    Vaccination: Meningitis
    Vaccination: MMR
    Vaccination: Tuberculosis

    Preparation for Adulthood

    Please provide details of where you live and with whom?

    Who do you live with?
    Do you need help with personal care (feeding, toileting, washing etc.)?

    Work Experience

    Have you had any Work Experience?
    What job do you want in the future?
    Have you ever had an interview with a Careers Adviser?
    Do you want to achieve . . . (Tick all that apply)

    Tell us about your qualifications and achievements

    English/Literacy

    What is your highest qualification in English?

    Mathematics/Numeracy

    What is your highest qualification in Maths?

    What other qualifications have you achieved?

    Acheived
    Level
    Date

    Acheived

    Level

    Date

    Acheived

    Level

    Date

    Acheived

    Level

    Date

    Acheived

    Level

    Date

    Acheived

    Level

    Date

    Acheived

    Level

    Date

    What qualifications if any, are you likely to achieve before leaving school?

    Likely to Achieve
    Level
    Date

    Likely to Achieve

    Level

    Date

    Likely to Achieve

    Level

    Date

    Likely to Achieve

    Level

    Date

    Likely to Achieve

    Level

    Date

    Likely to Achieve

    Level

    Date

    Likely to Achieve

    Level

    Date

    Learning Strategies

    Do you receive 1:1 support within the classroom?
    Do you receive 1:1 support outside the classroom?
    How do you learn best? What is your preferred learning style?
    What motivates you?
    Are there any particular activities that we should avoid when working with you?

    Communication Details

    Do you have any problems with your understanding of speech?
    How do you communicate? e.g. noises, signing, gestures, body language, symbols

    Agree & Consent

    Privacy Notice How We Use Your Personal Information

    Landmarks Specialist College recognises and understands that the efficient management of its data and records is necessary to support its core educational and business functions, to comply with its legal, statutory and regulatory obligations, to ensure the protection of personal information and to enable the effective management of the College.

    This document, meet the standards and expectations set out by contractual and legal requirements, and has been developed to meet the best practices of business records management, with the direct aim of ensuring a robust and structured approach to document control and systems.

    Why are we asking how you would like to be contacted? How long do we keep and store your data? Find out at www.landmarks.ac.uk/policies-reports/

    You can change your preferences anytime.

    By completing this form, your confirm that the information provided is correct and you are wanting to be contacted by Landmarks Specialist College.

    How would you like to be contacted?

    lease tick the box for your preferred method of contact.

    What information would you like to receive?

    Please tick the box for what we can contact you about.