Multiple Learner Exit Form (Non Apprenticeship)Learner Exit Form This form is to be completed by the Curriculum Manager when multiple learners complete and achieve the same programme. Curriculum Managers must ensure that the evidence uploaded such as the IQA report, Certificate Claim and/or examination results contains the details of all learners listed within the Learner Exit Form.Please select the Exit Type for the learner:- Select -Completed and AchievedCompleted (Awaiting Results)Course Title:Level :- Select -Non-AccreditedEntry Level 1Entry Level 2Entry Level 3Level 1Level 2Level 3Level 4Level 5How many learners would you like to complete/achieved? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20First Name (1):Surname (1):Date of Birth (1):Cohort (1)- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (1):Destination (1):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (2):Surname (2):Date of Birth (2):Cohort (2):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (2):Destination (2):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (3):Surname (3):Date of Birth (3):Cohort (3):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (3):Destination (3):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (4):Surname (4):Date of Birth (4):Cohort (4):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (4):Destination (4):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (5):Surname (5):Date of Birth (5):Cohort (5):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (5):Destination (5):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (6):Surname (6):Date of Birth (6):Cohort (6):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (6):Destination (6):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (7):Surname (7):Date of Birth (7):Cohort (7):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (7):Destination (7):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (8):Surname (8):Date of Birth (8):Cohort (8):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (8):Destination (8):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (9):Surname (9):Date of Birth (9):Cohort (9):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (9):Destination (9):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (10):Surname (10):Date of Birth (10):Cohort (10):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (10):Destination (10):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (11):Surname (11):Date of Birth (11):Cohort (11):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (11):Destination (11):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (12):Surname (12):Date of Birth (12):Cohort (12):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (12):Destination (12):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (13):Surname (13):Date of Birth (13):Cohort (13):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (13):Destination (13):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (14):Surname (14):Date of Birth (14):Cohort (14):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (14):Destination (14):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (15):Surname (15):Date of Birth (15):Cohort (15):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (15):Destination (15):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (16):Surname (16):Date of Birth (16):Cohort (16):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (16):Destination (16):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (17):Surname (17):Date of Birth (17):Cohort (17):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (17):Destination (17):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (18):Surname (18):Date of Birth (18):Cohort (18):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (18):Destination (18):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (19):Surname (19):Date of Birth (19):Cohort (19):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (19):Destination (19):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationFirst Name (20):Surname (20):Date of Birth (20):Cohort (20):- Select -Adult Learner (Loan/AEB/Private)ApprenticeshipTraineeshipSchool (6FORM)Study ProgrammeLast date of attendance (20):Destination (20):- Select -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 EmployedUnemployed and undertaking voluntary workUnemployed and looking for workUnemployed and not looking for workFurther EducationCertificationWill a certificate require claiming for these learners? Yes NoPlease upload relevant IQA evidence:Choose File Please upload Certificate Claim Form:Choose File Please upload evidence of achievement:Choose File DeclarationCurriculum Manager Name:- Select -Claire LambertDan WilliamsGeorgina Holiday / Beckie BacheJackie VincentJane WilliamsKathy BarnesLinda FriendMichelle TippettRachel BushSally SharpeCurriculum Manager E-mail:Curriculum Manager Signature: Sign Here OPTIONAL: 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? Yes NoPlease attach any additional evidence here:Choose File Submit Form