Make a Referral | JEP Youth Engagement

Host Setting Name

Host Setting Locality

Name of Lead Professional for Referral

Lead Professional Email Address

Lead Professional Contact Number

Host Settings's Main Email Address

Date of Referral

Pupil Information

Surname

Forename(s)

Date of Birth

Age

Year Group

Main Home Address

Who Does the Pupil Live With

Other Home Address(if applicable)

Ethnicity

First Language

Pupil Premium (Y/N)

Free School Meal (Y/N)

Parent/Carer Details - 1st Contact

Name

Relationship to Student

Address

Home Telephone

Mobile

Work Number

Place of Work

Unusual Work Hours

Email Address

First Language

Parent/Carer Details - 2nd Contact

Name

Relationship to Student

Address

Home Telephone

Mobile

Work Number

Place of Work

Unusual Work Hours

Email Address

First Language

Parent/Carer Details - 3rd Contact

Name

Relationship to Student

Address

Home Telephone

Mobile

Work Number

Place of Work

Unusual Work Hours

Email Address

First Language

Reasons For Referral (Tick All That Apply)

Incidents at School That Have Given Rise to Concern (Tick All That Apply)

Aims of Placement

Safeguarding

Social Care Involvement(Y/N)

Child Protection (Y/N)

Child in Need (Y/N)

Child Looked After (Y/N)

Early Help Assessment (Y/N)

Does The Pupil Have Any Caring Responsibilities?

Agency Involvement

CAMHS

Educational Psychology

School Nurse

Family Support Worker

Youth Offending Team

Behaviour Support Service

Virtual School

Early Intervention Team

Other

Medical Needs

SEN Information

What is/are the pupil’s primary need(s)?Communication and Interaction

Cognition and Learning

Social, Emotional and Mental Health

Physical

What Provision Have You Identified That Would Match The Needs of The Pupil?

Academic:
Our curriculum, rooted in English & Maths, adapts the National Curriculum to meet individual needs, fostering a love of learning through personalised, flexible teaching beyond a typical mainstream offer

Blended:
Starting with each learner’s specific needs and strengths, the blended pathway combines elements of both our Academic and My Future

Enrichment - MY Future (Mentoring Your Future)
Designed to raise aspirations and promote a sense of personal pride in achievement that includes a wide range of enriching experiences and opportunities

Pioneer:
A blend of academic curricula for young people working at or below ARE, with additional pastoral support and intervention elements according to need

Enrichment/Life Skills – Adventurer:
A non-academic curriculum for young people designed to raise aspirations and promote a sense of personal pride in achievement that includes a wide range of enriching experiences and opportunities

Forest School:
Through guided activities like outdoor craft and tending to the JEP Allotment, our young people build resilience, confidence and independence through interaction with the natural world around them

Education Details - Academic Attainment

English Reading Grade

English Reading Exam Board

Comments (English Reading)

English Writing Grade

English Writing Exam Board

Comments (English Writing)

Phonics Screening Grade (if applicable)

Phonics Screening Exam Board

Comments (Phonics Screening)

Maths Grade

Maths Exam Board

Comments (Maths)

End of KS1 Results (if applicable)

KS1 Exam Board

Comments (KS1)

End of KS2 Results (if applicable)

KS2 Exam Board

Comments (KS2)

Option Subjects Grades

Option Subjects Exam Boards

Comments (Option Subjects)

JEP Youth Engagement
Referral Form

JEP Youth Engagement
Referral Form

School Referrer Details

Pupil Information

Parent/Carer Details - 1st Contact

Parent/Carer Details - 2nd Contact

Parent/Carer Details - 3rd Contact

Reasons For Referral (Tick All That Apply)

Incidents at School That Have Given Rise to Concern (Tick All That Apply)

Aims of Placement

Safeguarding

Agency Involvement

Medical Needs

SEN Information

What Provision Have You Identified That Would Match The Needs of The Pupil?

Education Details - Academic Attainment

Attendance & Behaviour Overview

Additional Information

JEP Youth EngagementReferral Form

JEP Youth EngagementReferral Form

School Referrer Details

Pupil Information

Parent/Carer Details - 1st Contact

Parent/Carer Details - 2nd Contact

Parent/Carer Details - 3rd Contact

Reasons For Referral (Tick All That Apply)

Incidents at School That Have Given Rise to Concern (Tick All That Apply)

Aims of Placement

Safeguarding

Agency Involvement

Medical Needs

SEN Information

What Provision Have You Identified That Would Match The Needs of The Pupil?

Education Details - Academic Attainment

Attendance & Behaviour Overview

Additional Information

JEP Youth Engagement
Referral Form

JEP Youth Engagement
Referral Form