Young Person Referral Form - for schools and local authorities

  •  

    Click the link below to refer a young person

    https://form.fillout.com/t/1wakAAMTGbeu

    You can always email referrals@targetedprovision.com or call us on 020 7661 7026

  • Young Person Referral Form - for schools and local authorities

  • Call us on 020 7661 7026 if you are not able to complete this form or have any questions.

    If you want to save and come back to the form later, select "Save " at the bottom of the form. It will ask you to sign in or register for Jotform. This is optional and you can skip this step by selecting "Skip Create Account".

  • Your contact details

    Please do not enter the young person's name
  • Please select your institution type*

  • Please do not include special characters in the institution name (e.g. * / - )

  • Do you need to add contact details of a Designated Teacher?*

  • Young person details

  • Date of birth of the young person
     / /
  • Gender of the young person*
  • Has this young person been referred to Targeted Provision previously?*

  • Profile of the young person:

    Kindly include as much information as possible about the young person's needs and any relevant information about them or regarding their education to date.
  • Does the young person have any additional educational or mental health needs?*
  • Are there any risks associated with working with this young person?*
  • Is the young person currently, or likely to become, involved in an education tribunal or similar?*
  • Is the young person permanently excluded?
  • Is the young person living out of county?
  • Does the young person have other provisions?
  • Is the young person an external exam candidate?

  • Supporting documents

  • Does the young person have any supporting documents which you can share with us?*
  • Which types of documents?*
  • Upload EHCP
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  • Upload YPRA
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  • Browse Files
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  • Information about where the tuition will take place

  • Should the tuition take place online or face to face?*
  • Where will the young person be while the tuition takes place?*

  • Weekly progress reports

    You will receive a PDF each week detailing the young persons lesson reports including engagement, attendance and progress. We are not able to send reports directly to parents/carers, however if other professionals need access to weekly reports (for example class teachers) please enter these below.

  • Primary contact details

    The primary contact is the person responsible for and who will oversee their sessions with the tutor. In most cases, this is the young person's parent, carer, school teacher or guardian. We will get in touch with them to coordinate the date/time/logistics of sessions. Their details will also be passed on to the tutor.
  • Primary contact's relationship to the young person*

  • ⚠️ You have entered your email address. Is this correct?

  • Thanks for confirming that you are the primary contact for {youngPerson12}

  • Has the primary contact been informed that we will be contacting them to set up the support?
  • Does this person give consent to the tuition?
  • Date the consent was given
     - -

  • Details about the support required

  • When would you like the tuition to start?*
  • Is there a specific date you would like the tuition to start?
     - -
  • What is the young person's school year?

  • Educational Level:
    We appreciate in some instances you will have little indication of a young person's working age, in this instance please select the highest level you think the young person could be working to, and add any further information to the pupil profile.

  • Please select the educational level that best describes the young person:*
  • Please select the subjects that the young person needs support in:
  • Please select the subjects that the young person needs support in:*
  • What key stage is the young person working at?
  • Which qualifications is the young person aiming for?*
  • What are the desired outcomes that the young person is working towards?


  • Targeted Provision programmes

    In addition to the bespoke packages of support we put in place, we offer some programmes to target specific areas of need.

     

    1) EAL for beginners: This is is programme designed to support young people who are new to the country and do not yet have school / college places. Tutors will teach basic English skills and support young people to make progress in speaking, listening, reading and writing.

    2) Metacognition: Tutors use resources and methods to help young people understand how they learn best, and support them to develop study skills. Most suitable for Years 6 and 10/11.

    3) Life Skills: Tutors provide young people with support to consider careers and further education opportunities, as well as some guidance on managing finances, CV writing, and attending interviews. 

    4) Functional Skills exams (Levels 1 and 2, English and Maths): We are a functional skills exams centre, so can arrange for young people to sit these qualifications. The cost is £199 for one qualification and £390 for two. We will provide further information upon receipt of referral if you select this option.

  • Select a programme*
  • Is this tuition due to start in the Easter holiday?

  • Our teachers

    Generally all of the tutors that we provide for referrals hold QTS, however we know that for some young people, a tutor or mentor with SEND specific or youth work support may be more suitable. We will only ever select a tutor, QTS or non QTS, who has the right experience to meet your young person's needs.

  • Please select the qualifications of teacher suitable for this request*

  • Additional comments regarding hours (optional)

  • How is this support being funded?*
  • Should the support continue during the school holidays?*
  • How easy is it to refer a young person to us? (optional)
  • Would you like to be sent this completed form as a PDF?*

  • ✅ You will receive a PDF version of the completed form via encrypted email after submitting

  • ✅ You will receive a PDF version of the completed form via email after submitting

  • When you click submit, a receipt will be sent to the referral email address - {yourEmail70}

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