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Literacy and Numeracy Enquiry Form
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Personal Details
First name
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Surname
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Gender
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Address
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Mobile / phone / email contact
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Alternative Contact
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Date of birth
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Were you born in the UK?
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Ethnic Origin
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Asian / Asian British-Indian
Asian / Asian British-Pakistan
Asian / Asian British-Bangladeshi
Asian / Asian British-Other
Black / Black British-African
Black / Black British-Caribbean
Black / Black Britsh-Other
Chinese
Mixed-White and Black Caribbean
Mixed-White and Black African
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Other
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Traveller
Employment Status
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Full Time Employed
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Unemployed on benefits
Sick Leave
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Unemployed Asylum Seeker
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Maternity Leave
Still at School
Voluntary Work
In Full Time Education
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If Employed, what work do you do?
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Who is your employer?
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If unemployed, how long have you been unemployed for?
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0-6 months
6-12 Months
12-24 Months
24-36 Months
36 + Months
Not Applicable
Benefit information
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Job Seekers Allowance (JSA)
Council Tax Benefit
Housing Benefit
Income Support (OR N/ASS SUPPORT FOR A/S)
Working Tax Credit
Pensions Credit
Incapacity Benefit (ESA)
Unwaged Dependant of the Above
Other - Disability Living Allowance
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No Benefits Claimed
Are you looking for work?
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If so, what work
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Do you want to learn to get work or get a better job?
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Do you want to learn for further study?
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Do you want advice on careers and work?
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Highest level of British qualifications achieved
Please note below
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Do you want a qualification?
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Do you need childcare?
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If yes, please add the ages of the children/child
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Do you have any learning difficulties or disabilites?
Please tell us if you need any extra support with your class
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Other Needs
Background | Aims | Barriers
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Contact Details
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