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Part one: Summary

Delivery Organisation

Title

Forename(s)

Surname

Gender

Date Of Birth

House Number

Address 1

Address 2

Address 3

County

Post Code

Home or mobile Number

Email Address

National Insurance Number

Start date with project

How did you find out about the project?

Part two: Eligibility

Have you been supported by any other European funded project in the past 12 months?

To be eligible for support through More Positive Together we need to check that you have the legal right to live and work in the UK. Tick one box to confirm the item of evidence you are providing:

Please record the passport, birth/marriage certificate or residency card number:

Passport/residency card expiry date: (N/A for birth/marriage certificates)

Part three: Employment Status

Are you in paid work of any kind?

In months, how long have you been out of work?

Has Covid 19 effected your employment in anyway?

If yes, How has Covid 19 effected your employment?

Are you currently looking for work/ required to look for work?

Are you currently in education or training?

Are you currently claiming any benefits?

If Yes, which benefits:

If other, please state

Part four: Ethnicity

Ethnicity

Do you identify yourself as being Cornish?

Part five: Education

Select one option below for the highest level of education or qualification you currently hold:

Do you hold an Entry, Level 1 (Grade D/E) or Level 2 (Grade C) Qualification in Maths?

Do you hold an Entry, Level 1 (Grade D/E) or Level 2 (Grade C) Qualification in English?

Do you hold an Entry, Level 1 (Grade D/E) or Level 2 (Grade C) in ESOL?

Part six: Household situation

Are you currently homeless or affected housing exclusion?

Do you currently live in a jobless household?

Do you currently live in a jobless household with dependent children?

Do you live in a single adult household with dependent children (lone parent)?

Will you need childcare support/facilities if you embark on this project?

Part seven: Other information

Are you an offender or ex-offender?

Do you consider yourself to have a limiting long-term health condition or disability?

Do you consider yourself to have a work limiting health condition?

Are you substance misuse dependent?

Part eight: Participant Declaration

Participant Declaration (tick each box to confirm)

I know that the support I will be offered is funded by the European Social Fund. The information provided in the form is, to the best of my knowledge, accurate. I am not in paid work of any kind, including any zero hours contract. If I have ticked a 'Participant chose not to say' option anywhere on this form, I confirm that I am refusing consent for this information to be collected. I give permission for my personal details to be shared with the partners who are signatories to the Information Sharing Agreement involved in the delivery of this project. I understand that this information will be retained until at least 31 December 2033 for evaluation purposes. After that time, it will be destroyed in a secure manner. I may be contacted at any time to discuss my involvement in the project. I understand that the DWP, Government Internal Audit Agency, AQA, Statutory bodies and signatories to the information sharing agreement may request to see this information at any time and that it can only be shared in a secure manner and never emailed

Participant Signed - Y/N

Participant Signed - Date

PAC Participant Entry form