16-18 Agreed Change Submission

16-18 Agreed Change submission

Where there are any agreed changes to be made to the Learning Agreement, such as changes to qualification aims these should be formally submitted via this form.

All changes (including learner personal details) must be signed and agreed by all parties (Learner and Training Provider). Where a Supporting Provider is involved in the delivery they can sign on behalf of the training provider.

A form must be completed and signed for every change made.

Learner First Name:

Learner Date of Birth:

Learner Surname:

Course:

Cohort:

STUDP (City College Plymouth Study Programme)

6FORM (6th Form learner attached to Home School)

Please note:

Any change relating to a learner who is linked with a Home School must be agreed and confirmed with the Home School prior to the change taking place. Therefore the change may not be completed with the 3 working day policy. All changes will be communicated through to schools by the MIS 16-18 Coordinator. Once the change has been actioned it will be made available within the 'Learner Online File'.

Please enter the name of the new Tutor / Assessor:

Previous Name:

Updated Name:

Name Change Evidence

Choose File

Previous Email Address:

New Email Address

Previous Address

New Address

Previous Telephone Number

New Telephone Number

New Next of Kin Name:

New Next of Kin Address:

New Next of Kin Telephone Number:

Please provide QAN code of qualification that requires changing

Please provide QAN code of new qualification:

Please provide start date of new qualification:

Planned end date of new qualification:

Tutor Name:

Room (If applicable):

Please provide reason for change:

Please provide the start time of the session:

Please provide the end time of the session

Please provide QAN code for the additional qualification:

Please provide start date of additional qualification:

Planned end date of additional qualification:

Tutor name:

Please provide the start time of the session:

Please provide the end time of the session

Please state the reason for the change in start date (Please note that it may not be possible to amend dates within the previous academic year) :

Please provide QAN code of qualification that requires attendance dates changing:

Please select the date that the the change take effect from:

Are there any additonal qualifications that require their attendance days amending?

Yes

Please provide QAN code of additional qualification that requires attendance dates changing:

Is there a third qualification that requires attendance days amending?

Yes

Please provide QAN code of additional qualification that requires attendance dates changing:

Is there a fourth qualification that requires attendance days amending?

Yes

Please provide QAN code of additional qualification that requires attendance dates changing:

Declaration

By signing this form I agree to the above changes being made.

Learner Signature:

Sign Here

Tutor/Assessor Name:

Tutor/Assessor Signature:

Sign Here

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16-18 Agreed Change Submission

16-18 Agreed Change submission

Declaration