Basic Assessment Form Please complete all parts of the form below. This form is part of our initial assessment procedure. We will use the information under candidate profile to register you as a candidate. Step 1 of 8 - 1 0% Candidate ProfileName First Last Enrolled Course* Course Start Date* DD slash MM slash YYYY Email* Contact Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Who has paid for your course?*EmployerSelfFamilyOtherHave you participated in an induction session?* No Yes Where do you work or volunteer?* Please provide a brief description of your role:*This should be related to the course you will be completing.What is your highest qualification?* Qualifications and Work Experience:*Identity Check RequirementWe are required by our regulators to check and confirm the id of every candidate.Type of ID Provided*PassportDrivers LicenseEmployer IDEU ResidenceBiometric residence permitHM Forces ID cardFirearms licenceOtherAttach ID:*Max. file size: 50 MB. DemographicsDate of Birth:* DD dash MM dash YYYY Gender:* Male Female Equality and Diversity Monitoring*English, Welsh, Scottish, Northern Irish, BritishIrishGypsy or Irish TravellerAny other white backgroundWhite and Black CaribbeanWhite and black AfricanWhite and AsianAny other mixed/multiple ethnic backgroundIndianPakistaniBangladeshiChineseAny other Asian BackgroundAfricanCaribbeanAny other Black/African/Caribbean BackgroundArabAny other ethnic backgroundPrefer not to say A bit about your selfDo you have a current Disclosure and Barring Service (DBS) check?* No Yes What is your specialist area?* What are your short term goals regarding your education?*What are your long term goals regarding your education?*Do you have any difficulties that might affect your progress on the course?*Is there anything else you want to be considered as part of your holistic assessment plan?* Motivation and prior learningWhat has motivated you to sign up for this course?*What do you know about the course so far (Please state key course requirements)?* Workplace SupportAre you going to rely on any expert witness evidence?* No Yes Do you have support from your managment (if applicable)?* No Yes Not Applicable Do you have a mentor within your workplace?* No Yes Not Applicable Do you have permission for us to carry out workplace assessments?* No Yes Not Applicable Learning Styles Questionnaire1) When I operate new equipment I generally:* a) read the instructions first. b) listen to an explanation from someone who has used it before. c) go ahead and have a go, I can figure it out as I use it. 2. If I am teaching someone something new, I tend to:* a)write instructions down for them. b) give a verbal explanation. c) demonstrate first and then let them have a go. 3. When I need directions for traveling I usually:* a)look at a map. b)ask for spoken directions. c)follow my nose and maybe use a compass. 4. When I am choosing a holiday I usually:* a)read lots of brochures. b)listen to recommendations from friends. c)imagine what it would be like to be there. 5. When I go shopping for clothes, I tend to:* a) imagine what they would look like on. b) discuss them with the shop staff. c) try them on and test them out. 6. When I am learning a new skill, I am most comfortable:* a) watching what the teacher is doing. b) talking through with the teacher exactly what I am supposed to do. c) give it a try myself and work it out as I go. 7. When I listen to a band, I can’t help:* a) watching the band members and other people in the audience. b) listening to the lyrics and the beats. c) moving in time with the music. 8. When I concentrate, I most often:* a) focus on the words or pictures in front of me. b) discuss the problem and the possible solutions in my head. c) move around a lot, fiddle with pens and pencils and touch things. 9. When I am anxious, I:* a) visualise the worst-case scenarios. b) talk over in my head what worries me most. c) can’t sit still, fiddle and move around constantly. 10. I feel especially connected to other people because of:* a) how they look. b) what they say to me. c) how they make me feel. 11. If I am explaining to someone I tend to:* a) show them what I mean. b) explain to them in different ways until they understand. c) encourage them to try and talk them through my ideas as they do it. 12. When I have to revise for an exam, I generally:* a) write lots of revision notes and diagrams. b) talk over my notes, alone or with other people. c) imagine making the movement or creating the formula. 13. I find it easiest to remember:* a) faces. b) names. c) things I have done. 14. I remember things best by:* a) writing notes or keeping printed details. b) saying them aloud or repeating words and key points in my head. c) doing or practising the activity or imagining it being done. 15. If I have to complain about faulty goods, I am most comfortable:* a) writing a letter. b) complaining over the phone. c) taking them back to the store or posting them back to head office. 16. I really love:* a) watching films, photography, looking at art or people watching. b) listening to music, the radio or talking to friends. c) taking part in sporting activities, eating fine foods and wines and dancing. What is your learning Style?* Visual (Spatial) Verbal Kinesthetic Numeracy AssessmentDo you have qualifications in GSCE Mathematics and English at Grade C or better or Numeracy and Literacy qualifications.* Yes No If you have answered yes above please provide details of your qualifications:Question 1: 8 + 2 – 3 =* Question 2: 3 x _____ = 5 + 5 + 5* Question 3: Round 270 to the nearest hundred:* Question 4: 1/3 = x/180 . What is x?* Question 5: A settee has a marked price of £200. There is now a sale of 20% off on the marked price. How much is the settee?* Question 6: What is the median number of 3, 13, 23, 39, 23, 14, 23 and 29?* Question 7: What is the mode number of 3, 13, 20, 11, 39, 11, 40, 11, 14, 12 and 11?* Question 8: What is the Mean of 12,18,6 and 4?* Question 9: 12 + 8 × (5 − 4)= b. What is b?* Question 10: What is the area of a rectangle with a height of 3m and 5m width?* Literary AssessmentType about 200 words explaining what has motivated you to enrol for this course?*Recognised Prior LearningAre you submiting any evidence for prior learning assesment?* No Yes If you have answered 'yes' above please tell us a bit about how you achieved your evidence?Please state the prior learning evidence you are submitting for prior learning assessment?Please attach your evidence: Drop files here or Select files Max. file size: 50 MB, Max. files: 10. Please sign below:*NameThis field is for validation purposes and should be left unchanged.