19+ Department Confirmation19+ Enrolment Form - Enrolling Officer Confirmation. In order for an online form to be processed by the MIS team the Enrolling officer must confirm that they have confirmed that the learner meets the requirements of the programme and is suitable for the course. Please complete all sections below ensuring that the enrolment form code is correct (this can be found in the email subject from the Admission team).Learner Name:Please confirm you have checked the learner ID held with the enrolment form: I have witnessed the learner and confirm that they are a true likeness to the identification submitted. The name is correct and recorded correctly on the enrolment form.Please confirm you have checked the details entered on the enrolment form : I confirm that I have reviewed the enrolment form and confirm that all details including the learner address and contact details are correct. Where a customer has stated they are in unemployed and in receipt of state benefits (which may result in the learner being fully funded for their programme), please state which benefit you have witnessed and can confirm the customer is in receipt of:- Select -Universal CreditJob Seekers AllowanceIncome SupportWorking Tax Credits / Child Tax CreditsEmployment and Support AllowanceCarers AllowanceOther (Please provide information in Notes section)Please state which Mathematics Assessment has been completed by the learner: Maths BKSB - Online Maths BKSB - Paper basedPlease upload evidence of the Maths assessment showing the level achieved:Choose File Please state which English Assessment has been completed by the learner: English BKSB - Online English BKSB - Paper basedPlease upload evidence of the English assessment showing the level achieved:Choose File Please note: If the learner is enrolling on a functional skills qualification, the relevant Diagnostic Assessment must be available. If the learner has completed paper-based initial assessments these must be sent to MIS prior to the enrolment being processed.Is there any RPL that needs to be applied to this learner and their programme: Adjustment required Adjustment not requiredAfter RPL has been applied please identify the amount of learning REMAINING for this programme of study:50Please attach a copy of any evidence on how RPL has been calulcated for this learner (to be stored in the learners online learner file)Choose File How many qualifications is the learner enrolling on: 1 2 3 4 5 6I confirm to the best of my knowledge the information supplied by the learner is correct I have determined the learners eligibility for this chosen programme. I have discussed and agreed a programme with the learner including level, course content and attendance requirements, start date and planned end date.I can confirm the start date for this learner is:I can confirm the QAN code for the programme is: I can confirm the planned end date for this learner is:Learner planned learning hours:- Select 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1 QAN Code:QUALIFICATION 1 Start Date:QUALIFICATION 1 Planned End Date:QUALIFICATION 1 Planned Learning Hours:- Select 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QUALIFICATION 2 QAN Code:QUALIFICATION 2 Start Date:QUALIFICATION 2 Planned End Date:QUALIFICATION 2 Planned Learning Hours:- Select 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3 QAN Code:QUALIFICATION 3 Start Date:QUALIFICATION 3 Planned End Date:QUALIFICATION 3 Planned Learning Hours:- Select 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QUALIFICATION 4 QAN Code:QUALIFICATION 4 Start Date:QUALIFICATION 4 Planned End Date:QUALIFICATION 4 Planned Learning Hours:- Select 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5 QAN Code:QUALIFICATION 5 Start Date:QUALIFICATION 5 Planned End Date:QUALIFICATION 5 Planned Learning Hours:- Select 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QUALIFICATION 6 QAN Code:QUALIFICATION 6 Start Date:QUALIFICATION 6 Planned End Date:QUALIFICATION 6 Planned Learning Hours:- Select 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5 QAN Code:QUALIFICATION 5 Start Date:QUALIFICATION 5 Planned End Date:QUALIFICATION 5 Planned Learning Hours:- Select 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QUAL' 1 QAN Code:QUAL' 1 Start Date:QUAL' 1 Planned End Date:QUAL' 1 Planned Learning Hours:- Select 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QUAL' 2 QAN Code:QUAL' 2 Start Date:QUAL' 2 Planned End Date:QUAL' 2 Planned Learning Hours:- Select 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QUAL' 3 QAN Code:QUAL' 3 Start Date:QUAL' 3 Planned End Date:QUAL' 3 Planned Learning Hours:- Select 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(Any changes required to the details completed on the learner enrolment form):How will the course(s) stated on this Department Confirmation be delivered to the learner?- Select -ClassroomRemoteBlendedEnrolling Officer Signature: Sign Here Enrolling Officer Signature Date:Enrolling Officer EmailSubmit Form