Item 6a
REGIONAL PROGRAMME:
Date Enrolled:
Enrolled in Claim:
80830
EX
PRESSION OF INTEREST
(Mae’r ddogfen hon ar gael yn Gymraeg /This document is available in Welsh)
The following are possible areas of support that can be offered by Inspire 2 Work to assist a participant:
Literacy Confidence building Course Advice Communication
Numeracy Mentoring Taster Sessions Job Search Skills
Digital literacy CV Development Work placements Work specific qualifications
Section 1
Personal Details
(To be completed by the individual requiring I2W support)
Name:
Address:
Postcode
Telephone No:
Email:
Date of Birth:
NI Number:
Gender:
Male
Preferred language:
Welsh
I confirm that the above information is correct and that I am not currently engaged in any form of education, employment
or training, including DWP Programmes (but excluding the Work and Health Programme).
Print Name: __________________________ Signature: ______________________ Date:__________________
Confirmation of Eligibility
PLEASE NOTE: Section 1 must be completed as well as EITHER Section 2A OR 2B
Section 2A (Preferred evidence) Only to be completed by DWP / Jobcentre Plus or Careers Wales / EPC:
Is the above named person engaged in any form of education, employment or training? If
yes, the participant will not be eligible for I2W support.
Yes No
I declare that the information provided is correct and to the best of my knowledge:
Print Name: _______________________ Signature: ______________________ Date:__________________________
Organisation: _____________________ Job Title:_______________________ Contact No.:____________________
Section 2B (Third party evidence)
To be completed by
all other individuals / organisations:
Is the above named person engaged in any form of education, employment or training? If
yes, the participant will not be eligible for I2W support.
Yes No
Please state your relationship with the above named individual.
Please state your relationship with the Inspire 2 Work operation (confirming
independence/ no conflict of interest).
Please confirm that you are independent to the direct management and delivery of the
Inspire 2 Work operation, with no conflict of interest (financial or other interest).
I declare that the information provided is correct and to the best of my knowledge:
Print Name: _______________________ Signature: ______________________ Date:__________________________
Organisation: ______________________ Job Title:_______________________ Contact No.:____________________
Office note: On completion of this section I2W staff must also attach the Confirmation of Eligibility Step 2 form
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