Learner Exit FormLearner Exit Form This form is to be completed by the Curriculum Manager when a learner leaves the course (completion or withdrawal). Where a learner has achieved their programme the appropriate evidence must be attached IQA forms/Certificate Claims. Please select the Exit Type for the learner:- Select -Completed and AchievedCompleted and Partially AchievedCompleted and FailedCompleted (Pending Results)Withdrawal (No achievement)Non-StarterCohort:- Select -Adult Learner (AEB/Loan/Private Single Aims)Apprenticeship (All Aims Inc. EPA)Apprenticeship (Single Aim)School (6FORM)Study Programme (All Aims)Study Programme (Single Aim)Tutor Name:Tutor Email:Learner First Name:Learner Surname:Date of Birth:Course Title:Level :- Select -Non-AccreditedEntry Level 1Entry Level 2Entry Level 3Level 1Level 2Level 3Level 4Level 5Start Date:Did the learner attend any sessions for this programme? Yes NoLast date of attendance for programme:Did the learner undertake English? Yes NoDid the learner achieve their English aim? Yes NoPlease provide the last date of attendance for English aim:Did the learner undertake Maths? Yes NoDid the learner achieve their Maths aim? Yes NoPlease provide the last date of attendance for Maths aim:Did the learner undertake additional aims? Yes NoPlease select aim to withdraw (for L2 Apprenticeships only): English Level 2 Mathematics Level 2Please provide the QAN code of the additional aim undertaken by the learner:Did the learner achieve this additional aim? Yes NoPlease provide the last date of attendance for the additional aim:Has the apprentice met the minimum 20% off the job training requirement? Yes NoPlease state the number of OTJT hours that are evidenced on their register(s) on PICS:Please state the reason why the learner has not met the minimum requirement:CertificationWas this learner registered with an Awarding Organisation? Yes NoWill a certificate require claiming for this learner? Yes NoPlease upload relevant IQA evidence:Choose File Please upload Certificate Claim Form:Choose File Will an additonal certificate require claiming for this learner? Yes NoPlease upload relevant IQA evidence:Choose File Please upload Certificate Claim Form:Choose File Destination - Learner EducationPlease state why the learner is being withdrawn: Change of career Relocation Personal reasons Lack of attendance Behaviour Other (Please add description to the right)Withdrawal reason description:Learner education destination:- Select -Progressing to another programme at ATLTransferring to another training providerProgressing to Higher EducationApprenticeshipNonePlease provide the date in which the learner started their education destination:Destination - Learner EmploymentLearner Employment Destination Working for the same employer (part time) Working for the same employer (full time) Working for a new employer (part time) Working for a new employer (full time) Self Employed Unemployed and undertaking voluntary work Unemployed and looking for work Unemployed and not looking for workPlease provide the date in which the learner started this destination:Was the learner unemployed and in receipt of benefits when they enrolled? Yes NoPlease upload evidence of the learners employment outcome:Choose File Employment Outcome EvidenceEmployment Outcome Evidence can be an e-mail from the learner, contract of employment or an email from the new employer. The evidence must state how many weekly hours they have been employed for and whether the contract has a minimum duration of 4 weeks. In addition to this the learner must also confirm whether or not they have stoppped claiming benefits relating to unemployment.Work PlacementDid the learner complete their Work Placement? Yes NoPlease provide the last date of attendance for the work placement:Please upload a copy of the learners work placement register:Choose File End Point AssessmentPlease upload evidence of End Point Assessment achievement:Choose File Please upload evidence of the EPA Gateway Declaration:Choose File Apprenticeship Withdrawal - Employer ConfirmationPlease upload evidence of the employers confirmation/request for withdrawal:Choose File DeclarationCurriculum Manager Name:- Select -Claire LambertDan WilliamsEmma CayGeorgina HolidayJackie VincentJane WilliamsJill WilliamsKathy BarnesLeigh Littley (FSELEMENT ONLY)Linda FriendMichelle TippettRachel BushRebecca KnightSally SharpeTracy WalkerVanessa HuntCurriculum Manager Email:Curriculum Manager Signature: Sign HereOPTIONAL: If you would like to add any further comments regarding this learner exit please add these here:Would you like to add any additional documents/evidence to this Exit request? (Including completed Individual Learning Plans) Yes NoPlease attach any additional evidence here:Choose File Submit Form
