Scribd
Upload
16 views3 pages

Enrolment Form Template v2

The document is an enrolment form for the NEBOSH International General Certificate in Occupational Health and Safety, which must be completed by a Tutor or Enrolment Officer. It collects personal, employment, and course-related details from the learner, including any additional learning support needs. The form also includes sections for assessing the learner's understanding of the course and their availability for attendance.

Uploaded by

princejn004
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
16 views3 pages

Enrolment Form Template v2

The document is an enrolment form for the NEBOSH International General Certificate in Occupational Health and Safety, which must be completed by a Tutor or Enrolment Officer. It collects personal, employment, and course-related details from the learner, including any additional learning support needs. The form also includes sections for assessing the learner's understanding of the course and their availability for attendance.

Uploaded by

princejn004
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

Enrolment Form

NEBOSH International General Certificate in Occupational Health and Safety


To be completed by the Tutor / Enrolment Officer

Learning Partner reference


Name of adviser
Date
Please complete all sections.
Please ensure details match those printed on official documentation (eg a passport).
All personal and employment information must be kept confidentially.

Learner details (please select ✘


, where relevant)

First/given
name
Last/family
name
Gender How does the learner describe their gender?
Male Female
Prefer to self-describe (non-binary,
gender-fluid, agender… please specify):
Date of birth
(day/month/year)
Residential
address

Contact
telephone
Contact email

Course details (please select ✘


, where relevant)

Does the learner have Yes No


reliable Internet access?
How would they rate Excellent Good Average Fair Poor
their IT skills?
First language
Second language(s)

Employment details (if applicable)


Job title
Length of time in role
Employer name
Employer contact
address

Additional learning support (to be discussed with the learner)

Enrolment form v2 Page 1 of 3


Additional learning support describes the support needed to manage or overcome a barrier to learning.

There are four categories of additional learning support needs (although this is not an exhaustive list,
and in no way excludes other conditions):
 Cognition and learning;
 Interaction and communication;
 Social, emotional and mental health;
 Sensory and/or physical difficulties.

If the learner has a condition (diagnosed or undiagnosed) that they feel is likely to impact their
ability to complete the course, please provide details below.

Ask the learner to provide a brief description of their condition


These might include (but not be limited to), for example: autism spectrum disorders, visual impairment, deaf, hard
of hearing, dyslexia, dyspraxia, dyscalculia, dysgraphia, dysphasia, ADHD

Ask the learner how their condition might prevent them from completing the course

Ask the learner what additional support can be provided to help them overcome the barrier(s)?

Enrolment (please select ✘


)

Enrolment form v2 Page 2 of 3


Have you explained the course syllabus to the learner? Yes No
Has the learner confirmed their availability to attend 100% of the Yes No
planned learning sessions?
Which country will the learner be in
while completing this qualification?

Give a brief outline of the learner’s role


and responsibilities.

Does the learner undertake high-risk


activities in their role? (eg manual
handling, hazardous substances,
working at height) – please provide
details.

Does the learner undertake risk Yes No


assessments?
Summarise the advice and guidance
given to the learner regarding the
suitability of the qualification to them.

Enrolment form v2 Page 3 of 3

You might also like