application form

A

Personal Details

Your basic personal information

First Name(s)*

Last Name / Surname*

Preferred Name (optional)

Date of Birth*

Home Address including postcode*

Mobile / Phone Number*

Email Address*

National Insurance Number*Required for registration and funding purposes

Unique Learner Number (ULN) (if known)Leave blank if unknown — we will find or create this

If self-describe, please specify (optional)

Right to work / study in the UK?*

Yes No — please contact us first

Nationality*

British EU / EEA Other — see below

If Other, please specify (if applicable)

B

Your Role & Care Setting

Work-based qualifications — access to an adult care setting is required

ℹYou do not need to be in full-time paid employment to apply. Paid, part-time, bank, agency and voluntary roles in adult care can all be suitable. What matters is regular access to a care setting where you can be observed practising your role.

What is your current role / relationship to adult care?*

Employed full-time in adult care Employed part-time in adult care Bank / Agency worker Volunteer in adult care Newly started (under 3 months) Not yet working in care — wanting to enter the sector

Current Job Title / Role*

Employer / Organisation Name*

Organisation Address including postcode*

Organisation Phone Number*

Organisation Email Address*

Supervisor / Manager / Coordinator Name*

Their Job Title*

If Other, please describe (if applicable)

How long have you been in this role / setting?*

Roughly how many hours per week are you in this care setting?*

Under 8 hours 8–16 hours 16–30 hours 30+ hours

C

Qualification Applied For

Tell us which level interests you and how you would prefer to learn

⚑The level you select here is provisional. It will be confirmed following your Initial Assessment.

Which qualification level interests you?*

Level 2 — Diploma in Adult Care Level 3 — Diploma in Adult Care Level 4 — Diploma in Adult Care Level 5 — Leadership & Management Not sure — please advise me

How would you prefer to learn?*

Mainly remote / online Mix of remote and on-site visits Mainly on-site workplace visits

Why do you want to do this qualification? What are your goals?*

Where do you see yourself in adult care in the next 2–3 years?*

D

Prior Qualifications & Experience

Helps us confirm the right level and recognise prior learning

Qualification Title	Awarding Organisation	Level / Grade	Year

Do you have prior learning or experience you would like us to consider?*

Yes — I have evidence of prior learning No

If yes, briefly describe (if applicable)

E

English, Maths & Digital Skills

Helps us provide the right support from day one

Highest English qualification*

Highest Maths qualification*

Is English your first language?*

Yes No

If No, what is your first language? (if applicable)

How confident are you using a computer or tablet?*

Do you have regular internet access?*

What device do you have access to for online learning?*

Laptop / Computer Tablet Smartphone only No device available

F

Support Needs & Adjustments

Strictly confidential — sharing this helps us support you better

ℹRiseLadder School is committed to removing barriers to learning. This will never affect your eligibility to apply.

Do you consider yourself to have a disability, learning difficulty or health condition?*

Yes No Prefer not to say

Please describe any support or adjustments that would help you (optional)

Have you received support or adjustments in previous education?*

Yes No

If yes, what support did you receive? (if applicable)

G

Safeguarding & Wellbeing

RiseLadder School is committed to safeguarding all learners and the people in their care

Do you hold a current DBS certificate?*

DBS Certificate Number (if held)

DBS Issue Date (if held)

Do you have any current or pending criminal convictions that may affect working with vulnerable adults?*

No Yes — I wish to discuss this confidentially with the team

Is there anything that might affect your wellbeing or ability to study during your programme? (optional)

No Yes — I would like to discuss this confidentially with my Assessor

H

How Did You Hear About RiseLadder School?

Helps us understand how learners find us

If Other, please specify (if applicable)

I

Declarations & Consents

Please read carefully before submitting your application

Please confirm your consents:*Data Consent (required) — I consent to RiseLadder School processing my personal data.Organisation / Employer Sharing (required) — I consent to RiseLadder School sharing relevant information with my employer/manager/coordinator.Marketing Updates (optional) — I am happy to receive updates.Case Study / Photography (optional) — I consent to promotional/quality use.

Learner Declaration: I declare that the information I have provided on this form is accurate and complete to the best of my knowledge. I understand that providing false or misleading information may result in my application being declined or enrolment being cancelled.

Full Name (as declaration)*

Date*

Signature (optional digital signature)

Date (optional)

🎓 RiseLadder School

Application Submitted