Build Your Basic English Skills - Online Course - Monday 9th, 16th, 23rd, 30th November, 7th and 14th December 2026 - 1.00pm

Learner enrolment form

Eligibility Please select, learners must meet one of the following categories You are enrolling for a Maths or English Functional Skills qualification, and you have not already achieved a GCSE grade 9-4 / A*-C in that subject Receive Income Support/Universal Credit Earn less than £26,800 annual gross salary At risk of / have mental health needs Currently unemployed AND seeking work Have refugee status Have a learning difficulty or disability Have the right to remain in the UK under the Afghanistan or Ukraine schemes

Please note: You do not need to have a diagnosed mental health condition to be eligible under the category "At risk of or experiencing mental health needs." This category may include learners who are affected by challenging life circumstances that impact their mental wellbeing

Learner's title Please select Mr Mrs Miss Ms Other

Learner's first name(s)

Learner's surname

Learner's date of birth (participants must be 19+)

Sex at birth Please select Female Male

How would you describe your gender? (optional)

Learner's ethnicity Prefer not to say English / Welsh / Scottish/ Northern Irish / British Irish Gypsy or Irish Traveller Any other white background White and Black Caribbean White and Black African White and Asian Any other mixed / multiple ethnic background Indian Pakistani Bangladeshi Chinese Any other Asian background African Caribbean Any other Black / African / Caribbean background Arab Any other ethnic group

Learner's Home Address

Learner's Home Postode

Learner's Contact Number (Home and mobile)

Learner's email address

Hampshire Achieves are committed to creating an inclusive learning environment. Do you have any mobility, accessibility, or learning support requirements Prefer not to say Yes No

If YES, please provide details below

Please note that you can make a request for additional support to your tutor to another member of staff at any time during your course.

Do you have right to live in the UK and is the address given above your permanent address? Yes No

If NO, please explain your residence permit or visa status

Are you an Asylum Seeker? No Yes

If YES, how long have you lived in the UK?

Have you been granted leave to remain in the UK under any of the following schemes N/A Afghanistan scheme Ukraine scheme

What is your current paid work status? Please select an option Employed for less than 10 hours per week Employed for 11-20 hours per week Employed for 21-30 hours per week Employed for 31 hours or more per week I am looking to get back into employment and have been for less than 6 months I am looking to get back into employment and have been for 6 – 11 months I am looking to get back into employment and have been for 12-23 months I am looking to get back into employment and have been for 24 - 35 months I am looking to get back into employment and have been for 36 months or more I am not looking to get back into employment/retired and have been unemployed for less than 6 months I am not looking to get back into employment/retired and have been unemployed for 6 – 11 months I am not looking to get back into employment/retired and have been unemployed for 12-23 months I am not looking to get back into employment/retired and have been unemployed for 24 - 35 months I am not looking to get back into employment/retired and have been unemployed for 36 months or more

If you are currently employed, please select the appropriate length of time you have been employed 12 months or more 7 – 11 months 4 – 6 months 3 months or less N/A

Are you claiming any of the following types of benefits? None Job Seekers Allowance (JSA) Employment and Support Allowance (ESA) Universal Credit Other State Benefit

Have you ever been a Looked After Child (In Care) / Are You a Care Leaver? No Yes Prefer not to say

Join our mailing list No Yes