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.