Application Stage

Participant Profile
This section to be completed by programme Leader. Please refer to Guidelines to assist with this form.
Programme: Region/Country:
Start Date: Sub Region:
Trustontrack Reference Number (automatically created):

Speak to a member of staff or call free on 0800 842 842 if you need help when completing the form.

R Your details:
First Name: Surname:
Address:

Postcode: E-mail:
Please tick (◊) the box if you would like to receive e-mail communications from The Prince’s Trust.

Telephone Home: Mobile: Work:

Gender Female Male Date of Birth (e.g. 30/12/85)

DSN 0188/3 © The Prince’s Trust 2007 – all rights reserved. The Prince’s Trust is a registered charity, number 1079675, incorporated by Royal Charter. The Prince’s Trust Trading Ltd, a company registered in England no 3161821.
R Please tick the box which describes your ethnic background:
White Mixed Asian/Asian British Black/Black British Chinese Other Ethnic Group

British White
 & Black Indian Caribbean Chinese Traveller/Gypsy
If you wish to specify: Caribbean
Pakistani African
English W
 hite & Black Other
Bangladeshi O
 ther Black
African background background
Scottish Other Asian
W
 hite & Asian background
Welsh
O
 ther Mixed Please state:
Northern Irish background
Irish
O
 ther White background

I prefer not to say

For Business applicants only: National Insurance Number

R What are you currently doing?

Unemployed For months
Working Full-time Part-time Job title:
Doing voluntary work (unpaid) Full-time Part-time
Undertaking education/training Full-time Part-time
In custody
Unable to work If so, why?
Not entitled to work If so, why?

Do you receive benefits? Yes No

If yes, please tick any which apply: Job Seeker’s Allowance Income Support
Incapacity Benefit Severe Disablement Allowance
Housing Benefit Disability Living Allowance

Are you on New Deal? Yes No

Do you receive any training/development allowances? If yes, please tick any which apply:
Education Maintenance Allowance (EMA) Volunteer Activity Allowance
 R Please answer the following questions:
Do you have a qualification? Yes No
If yes, please state your highest qualification and grade:
• If GSCE/SCE is your highest qualification, have you achieved 5 GCSEs Grades A* to C / 5 Yes No
SCEs Standard Grade 1 to 3?
• What is your highest qualification and grade in English/Welsh/Gaelic?
• What is your highest qualification and grade in Maths?
Are you currently in care? Yes No
Are you leaving or did you leave care between the ages of 16 and 21? Y
 es No
• If yes, was this in the last 12 months? Yes No
Are you currently under the supervision of a criminal justice agency in the community, in
custody, or subject to any other sentence? Yes No
In the last 12 months have you had a formal reprimand/final warning or finished a period
of supervision by a criminal justice agency, finished a period custody, or finished any Yes No
other sentence?
Do you consider yourself as having a disability? (A disability is something that can be physical or mental Y
 es No
and affects your day to day life. It can take many forms e.g. needing to use a wheelchair, having a long term illness, severe
asthma, dyslexia, epilepsy, ME, depression or anxiety). Prefer not to say
• If yes, please describe:
Are you a lone parent? (i.e. Do you have a child?) Yes No
Are you a Refugee? (This means you came to the UK on your own or with family because of problems in your home
country and you are allowed to stay) Yes No
Are you an Asylum Seeker? (This means you came to the UK on your own of with family because of problems in
your home country and you do not know if you are allowed to stay)
Y
 es No

R What is your religion? Please tick one box only.

Catholic Protestant Other Christian Buddhist
Hindu Jewish Muslim Sikh
Any other religion (please specify) None I prefer not to say

R Where do you currently live?

In rented accommodation With parents/guardians/carers In a children’s home
In supported accommodation  emporarily staying with friends/
T In custody
(i.e. there are staff who support you) relatives (including sofa surfing)
In a home that I own In a temporary hostel Sleeping rough
Other (please specify)

R What challenges do you face?

Problems with numbers/maths Workless household (i.e. no-one in your home is in paid work)
Problems with reading/writing Drug issues
History of offending Alchohol issues
Mental Health issues Rurally isolated (i.e. living away from town facilities)
Problems in my relationships with family/friends/partners Other (please specify)

R How satisfied do you feel with your life at present?

Very satisfied  uite
Q Neither satisfied Quite Very dissatisfied
satisfied nor dissatisfied dissatisfied

R What do you plan to do once you’ve finished the programme / received your Award?
Get a job/be self employed  P lease specify the type of work you would like to do?
(e.g. catering, construction, etc…)
Go into education or training Voluntary Work
International travel Don’t know / not yet decided
Other (please specify)
I agree that the information given above can be used by The Prince’s Trust, and other organisations working with them, to help run, fund and evaluate The
Prince’s Trust programmes. I understand my right to ask to see the information held about me by The Prince’s Trust.

Signed Date: