Schools & Local Authority Shop Community Projects

Local Authority - Young Person Referral Form

Are you a School or Local Authority?

CERA Cycloan’s Alternative Educational Provisions are aimed at re-engaging learners in a very practical way, supporting and empowering them to set their own goals whilst working within a structured curriculum. Our provisions are designed to improve a learner’s confidence and self-esteem, and help them develop the life skills they need to consider a new pathway. Visit our School and Local Authority page to find more information about the engaging educational classes we offer. If you would like to refer a learner to one of our engaging Alternative Educational Provisions, please fill and submit the form below and a member of the team will be in touch shortly!

Referrals

Which service are you referring from?

Who is making this referral?


YesNo

Who Is Being Referred?

What would your client like to engage with?


YesNo


YesNo


YesNo

Please Tell Us All Risk Factors


YesNo


YesNo
If yes, please give detail:


YesNo


YesNo


YesNo



YesNo



YesNo



YesNo

When Would You Like The Referral To Start From and Finish?

I'm unsure about an end date, please contact me to arrange a bespoke arrangement

Feedback and Reporting Contacts

Billing Information

If The Student Has An EHCP - please attach a copy here:
Please attach any risk assessments here:


It is important that we receive the correct information to ensure the correct levels of knowledge and support are in place i.e. 1 to 1 supervision and general safeguarding procedures.

Please Note: Once referred if the individual’s behaviour does not match the risk factors detailed on this referral form, you will be contacted, this may result in fees being altered to match the Risk factors, Risk Assessments or Educational Health Care Plan needs.

I've read and understood the above statements, and all information above is correct to the best of my knowledge


Please prove you are human by selecting the Plane.