Apply Online Application and Enrolment Form Please select which course you are applying for:(Required) Level 3 Diploma in Veterinary Nursing Level 2 Veterinary Nursing Assistant - Small Animal Level 2 Diploma Veterinary Nurse Assistant - Equine Which month do you wish to start the course?(Required) January April September Tick more than one box if you are flexibleLearner DetailsName(Required) DrMissMrMrsMsProf.Rev. Prefix First Middle Last Date of Birth(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required)Current Address & Postcode(Required) 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 Postcode prior to enrolment(Required)Telephone Number(Required)Email Address(Required) Enter Email Confirm Email National Insurance Number(Required)Emergency Contact detailsParents/Guardian Name: (if 16-17 years old)Emergency Contact Name(Required)Emergency Contact Number(Required)Emergency Contact Email Address(Required) Enter Email Confirm Email EligibilityDo you have the right to work in the United Kingdom?(Required) Yes No What is your place (country) of birth(Required)What is your Nationality?(Required)In which country do you normally live?(Required)If you are, or have been, living overseas please state your date of entry into the UKDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Have you been resident in the UK/EEA (European Economic Area) for the last 3 years?(Required) Yes No If No to questions above, are you a non-EEA citizen with permission from the UK government to live in the UK, (not for educational purposes) and have been ordinarily resident in the UK for at least the previous three years before the start of learning Yes No If NO to all above, please discuss with your tutor your eligibility for funding. Reasons and evidence seen for eligibilityWill you spend at least 50% of your working hours in England or Wales over the duration of the apprenticeship?(Required) England Wales Are you using a student loan to pay for your apprenticeship?(Required) Yes No Have you been asked to contribute financially to the cost of training, on-programme or end-point assessment?(Required) Yes No Will you be able to complete the apprenticeship within the time available?(Required) Yes No Household Situation (for ESFA purposes), please tick appropriate box:(Required) 1. No household member is in employment and the household includes one or more dependent children 2. No household member is in employment and the household does not include any dependent children 3. Learner lives in a single adult household with dependent children 4. Learner has withheld this information 5. None of the above apply Education (qualifications already gained or predicted grades please state.) Include all qualifications.Education (qualifications already gained or predicted grades please state.) Include all qualifications.(Required)TitleGradeYear Achieved Add RemoveClick the plus icon on the right to add additional rowsName of last School/College(Required)Have you ever been registered as a student VN with the RCVS?(Required) Yes No If YES please provide details of college attended, exams etcAre you currently enrolled on another course?(Required) Yes No If YES please give detailsHave you undertaken an apprenticeship before?(Required) Yes No If YES please give detailsDo you have any criminal convictions? Are you in custody as a prisoner, remanded in custody or have any other restrictions placed upon you which would interfere with your attendance at work?(Required) Yes No If YES please give detailsAre you in higher education, including on a holiday period?(Required) Yes No Are you taking part in any other employment, training or enterprise programme or scheme funded by the government?(Required) Yes No Are you working towards a degree (full or part time)?(Required) Yes No Do you currently hold a level 4 or higher qualification e.g. degree, certificate of higher education?(Required) Yes No Are you self-employed?(Required) Yes No I confirm that if I am a volunteer, I receive no payments for the work undertaken other than incurred expenses where payable Yes No Previous Employment HistoryPrevious Employment HistoryName of Employer and DatesJob Role and/or description of duties Add RemoveClick the plus icon on the right to add additional rowsEthnicityPlease tick the appropriate box(Required) British - English / Welsh / Scottish / N. Irish 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 Any other Asian background Caribbean African Any other Black background Chinese Arab Any other ethnic group Additional Support: Learning and Social (This can be discussed confidentially if preferred)Describe any support needs that you think we need to be aware of. This includes Dyslexia, Dyspraxia, Dyscalculia or areas which will impact on your qualification and others around you i.e barriers to your learningMedical Condition (This can be discussed confidentially if preferred) (Please tick)Medical Condition(Required) No Disability/Health Condition Visual Impairment Hearing Impairment Moderate Learning Difficulty Disability affecting mobility Autism spectrum disorder Emotional/Social difficulties Severe learning Difficulty Speech, Language and Communication Needs Mental Health difficulty Profound Complex Disabilities Dyslexia Dyscalculia Temporary disability after illness/accident Asperger’s Syndrome Other ConsentsPhotographic consent(Required) Please tick to confirmIn a continuous effort to promote Apprenticeships in the veterinary industry and good practice in training, Abbeydale Vet Nurse Training invite you to be involved in and / or participate in events / activities which may later be presented on the internet or in publications, including in-house promotional material. This Agreement / Permission form confirms your acceptance of these terms. I agree that Abbeydale Vet Nurse Training are permitted by me to use interviews, quotes, photographs, film or reproductions thereof which may be produced at any time, in any manner or form to reasonably promote or advertise Abbeydale Vet Nurse Training. The photographs / film will not be used for any other means. The copyright on any such material shall be assigned to Abbeydale Vet Nurse Training.Initial Assessment confirmation (to be undertaken prior to interview)(Required) Please tick to confirmIn a continuous effort to promote Apprenticeships in the veterinary industry and good practice in training, Abbeydale Vet Nurse Training will require you to complete these assessments under exam conditions and MUST only be completed by you. I agree to complete these assessments and have no assistance or use any other means to complete the answers. I understand that if found to be in breach of this then I could be withdrawn or refused access to the Abbeydale Vet Nurse Training apprenticeship program.Learner Privacy NoticeRetrieval of Unique Learner Numbers for Funded Programmes. How We Use Your Personal Information. This privacy notice is issued by the Education and Skills Funding Agency (ESFA), on behalf of the Secretary of State for the Department of Education (DfE). It is to inform learners how their personal information will be used by the DfE, the ESFA (an executive agency of the DfE) and any successor bodies to these organisations. For the purposes of the General Data Protection Regulations 2016, the DfE is the data controller for personal data processed by the ESFA. Your personal information is used by the DfE to exercise its functions and to meet its statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009 and to create and maintain a unique learner number (ULN) and a personal learning record (PLR). Your information may be shared with third parties for education, training, employment and well-being related purposes, including for research. This will only take place where the law allows it and the sharing is in compliance with the General Data Protection Regulations 2016. Government Authorities (or agents acting on its behalf) may contact you in order for them to carry out research and evaluation to inform the effectiveness of training.You can opt out of contact for other purposes by ticking any of the following boxes if you do not wish to be contacted: About courses or learning opportunities For surveys and research By post By phone By e-mail Further information about use of and access to your personal data, and details of organisations with whom we regularly share data are available at: https://www.gov.uk/government/publications/esfa-privacy-notice Tick to confirm that you have read and understood this Privacy Notice and authorise Abbeydale Vet Nurse Training to retrieve my ULNEmployment StatusName and address of EmployerContact person(Required)Contact phone number(Required)Contact Email Address(Required) Enter Email Confirm Email Start DateDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Contracted hours per week*Hourly Pay (£)Has the apprentice signed a full contract of employment? Yes No Do you have a job description Yes No Job TitleIf you have ticked yes because you have a job description, state your job title hereHave you had a Health & Safety Induction? Yes No Holiday entitlement: Minimum legal requirement – 28 days including Bank HolidaysPlease note that this apprenticeship with Abbeydale Vet Nurse Training is an ESFA Apprenticeship funded programme.Signature of Learner(Required)Type your name as your signatureDate of signatureDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of Training practice RepresentativeUpload qualification certificates(Required)Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB.We require: Any relevant qualification certificates such as GCSE's, Functional/Key Skills, Diploma or Degree Certificates Upload scan of Passport or Driving License(Required)Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB.Photograph or scan either your passport or your driving license and upload it here Upload photo(Required)Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB.The photo should be a passport type head and shoulders shot with a plain background. It can be a self imageUpload CV(Required)Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB.Upload your CVCover letter from employer(Required)Accepted file types: jpg, jpeg, png, pdf, Max. file size: 128 MB.The cover letter should be a statement from the employer of the apprentice to show that they are happy to support the student through the training. It must be signed and dated by the employer or training practice representative.Photography Consent(Required) Yes No I consent to Abbeydale, my training provider, using my photograph in promotional material, on social media and/or other publications which they may produce relating to training provision.Video or Voice Recording Consent(Required) Yes No I consent to Abbeydale, my training provider, using video or voice recordings for promotional material, on social media and/or other publications they may produce relating to training provision.External Party Media Coverage Consent(Required) Yes No I consent to be photographed/filmed by an external party relating to media coverage whilst training at AbbeydaleInformation Accuracy(Required) Yes No I confirm the information I have given on this form is accurate and true❖ Fees are payable within 28 days of receiving the invoice, should you leave the course after the commencement of the term, fees will still be due. ❖ RCVS and CQ enrolment fees (if applicable) are due on the first day of term- further information will be provided on induction day.I consent to my submitted data being collected and stored*(Required) Yes, I consent to my submitted data being collected and stored To comply with the EU's General Data Protection Regulation coming into force in May 2018, please tick yes to confirm that you consent to your submitted data being collected and stored.
