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Alternative Provision Referral

Please complete this form in full to refer a young person to one of our alternative provision programmes. All information will remain confidential and will be used to assess suitability and tailor support where needed.

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Referrer Information

Young Person’s Details

Parent/Carer Information

Preferred Method of Contact

Health & Additional Needs

Does the young person have any diagnosed medical conditions, SEN or EHCP?
Does the young person take any medication?
Any known behavioural or safeguarding concerns we should be aware of?

Reason for Referral

Please explain why you are referring this young person for alternative provision.

Include any background on exclusions, suspensions, disengagement from mainstream, or personal challenges.

Preferred Provision

Please select which of our alternative provision programmes you are referring to. You may select more than one if unsure.

Preferred Provision

Availability & Support

Preferred Location

Packages Available

Please choose which package would suit your individual.

Primary School Packages – 1, 2 or 3 days(required)
Secondary School Packages – 1 or 2 days(required)
Is transport required or will the child be brought to the venue?
Any additional support required to help the young person access the provision? (e.g. 1:1 support, behaviour mentor, visual resources)

Consent

I confirm that I have parental responsibility and give consent for this referral to be made to Complete Coaching for Alternative Provision support.
I consent to my information and the young person’s information being shared with Complete Coaching staff for the purpose of assessing this referral and delivering provision.(required)