Sheaf Specialist Vocational College

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1 (Including New Routes and My Learning My Way) Application Form Sheaf Specialist Vocational College About the programme that you are applying for Individual Learning Programme You are applying for an education study programme run through Sheaf Specialist Vocational College that will help you work towards and achieve the outcomes written in your Education Health & Care Plan*. If it is agreed that an Individual Learning Programme is appropriate, we will work with you and people important to you to develop a relevant and stimulating programme of learning with appropriate support You may want to ask someone who supports you to complete the form on your behalf. *These programmes are for learners with Special Educational Needs and Disabilities. You will need to have an Education, Health and Care Plan assessment to start this course. What you want from your programme To help us understand more about your needs please answer all questions below The reason/s I am applying for an individual programme through Sheaf Specialist Vocational College; Your personal goals (short/long term); If you are interested in Supported Internships tick here; 1

2 About you Surname Mr Mrs Miss Ms First name(s) Other Address Male Female Date of Birth NI number Current/previous school or college Telephone When will you leave this school/college? Mobile Preferred communication style / language Parent/Guardian (for under 18s or where the young person has limitations to mental capacity/ subject to best interest decisions) Name Telephone (day) Relationship to you Telephone (eve) Mobile Your Employment Status Are you in paid employment, or looking for work? Benefit Indicators Are you in receipt of Job Seekers Allowance (JSA)? Are you in receipt of Employment and Support Allowance - Work Related Activity Group (ESA WRAG)? Are you in receipt of another state benefit other than JSA, Universal Credit or ESA (WRAG)? Are you in receipt of Universal Credit? Are you in receipt of Disability Living Allowance (DLA) or Personal Independence Payment (PIP)? 2

3 Your Nationality What is your nationality? Have you lived in the UK or the EEA continuously over the last three years? If you lived outside the UK, what date did you enter? (date) Have you changed address in the last three years? Previous address If in another Country, where? Do you have Leave to Remain in the UK? Dates to/from How would you describe your ethnic origin? (please tick as appropriate) Arab Mixed (White/Black Asian) Asian or Asian British (Bangladeshi) Mixed (White/Black African) Asian or Asian British (Indian) Mixed (White/Black African Caribbean) Asian or Asian British (Pakistani) Mixed (any other mixed background) Asian or Asian British (any other Asian background) White (British) Black or Black British (African) White (Irish) Black or Black British (Caribbean) White (any other White Background) Black or Black British (any other Black background) Gypsy or Irish Traveller Chinese Romany Any other t known/not provided About your Education Which grades and /or qualifications (or equivalent) do you have / are likely to achieve? English N/A Pre E1 E2 E3 L1 L2 GCSE Entry (grade/date) Maths N/A Pre E1 E2 E3 L1 L2 GCSE Entry (grade/date) ICT N/A Pre E1 E2 E3 L1 L2 GCSE Entry (grade/date) 3

4 Details of any BTEC / EDEXCEL / AQA/ NVQ / ASDAN or other awards About your areas of interest (tick box beneath all that apply) Administration Creative Media Motor vehicle maintenance Animal Care: Domestic Duke of Edinburgh Award Scheme Music (specify level) Animal Care: Large Engineering Painting and Decorating Angling Environmental Conservation Performing Arts: drama Arts and Craft Farming Photography Building Crafts Hair and Beauty Public Services Business Horticulture/Gardening Reception Duties Catering and Hospitality Independent Living Retail Childcare Independent Travel Science Computing Jewellery making Sports, exercise and Leisure Construction Manufacturing Volunteer and charity work (specify) Other interests (specify) About your Support Do you have additional needs? Do you have an Education Health & Care plan? Have you been assessed as in need of Social Care support package? 4

5 What do your support needs relate to (tick as many as apply in the table below) Visual impairment Hearing impairment Disability affecting mobility Profound complex disabilities Social and emotional difficulties Mental health difficulty Moderate learning difficulty Severe learning difficulty Dyslexia Dyscalculia Other disability Prefer not to say Autism spectrum disorder Asperger s syndrome I prefer someone to call me to discuss my support needs (tick) Medical (please tell us your condition) Which of the above is your primary learning difficulty, disability, and/or health problem Preferred Learning Styles One-to-one tuition Group learning Exam Other (please state) Discreet/ embedded learning Portfolio development Centre assessment Other services you may receive support from Social Care Name: Contact details: MAST Name: Contact details: Youth Offending Team Name: Contact details: Community health team: Name: Contact details: Other (please state) Name: Contact details: 5

6 How you heard about us Please tell us how you heard about Sheaf College (if this was through a person who helps you please tells us their name and job title) Other applications If you are also applying for a learning programme with another college, training provider or school please tell us here: Criminal Convictions We need to make sure that we are supporting all our learners safely and that they are in the right programme for their needs. To help us plan our support, please tick as below. Do you have a Criminal Conviction, or any pending court cases / prosecutions? (You are not legally obliged to tell us about any spent convictions) Next steps Send this form to; Progressions Team, Lifelong Learning and Skills, 145 Crookesmoor Road, Sheffield, S6 3FP Or to: Sheaf Specialist Vocational College is a Local Authority provision. Our admissions team will contact Sheffield s SEND team and may contact other relevant agencies who have supported you (e.g. your school or Social Care) to ask for further information about your support needs. The decision about which placement will be named in your EHC plan will be made by the Local Authority s SEND team and the plan writers. A note on Data Protection We make sure that all our staff are very careful with any information that you provide and follow our data protection policies. You can find full information about this at 6

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