ON TRACK - SECURE REFERRAL FORM

HOW TO MAKE A REFERRAL:

We’ve kept our referral process quick and simple, it only takes a few minutes to complete. Once you submit the form, our team will handle the next steps and keep you informed every step of the way.

ABOUT YOU (REFERRER)

We’ll first collect some details about you, the person making the referral. This ensures we can update you on progress and get in touch if we need any additional information.

YOUNG PERSON'S DETAILS

Next, we’ll ask for information about the young person you’re referring. This helps us understand their situation and make sure we provide the right support.

ABOUT YOU (REFERRER)

First name

Last name

Phone

What organisation do you work for? (If this is a self referral please put 'self referral'.)

Before we go any further, we would like to confirm the funding arrangements for this referral. If you don't have funding in place yet, please don't check the checkbox below and we will contact you to discuss.

Have you already got funding in place for this referral?

Yes

YOUNG PERSON'S DETAILS

Full Name

Date of Birth / Age

Gender / Pronouns

Address and postcode

Parent/guardian name(s) and contact information

Emergency contact phone number

Emergency contact email

EDUCATION AND BACKGROUND

Current/Previous school or education setting

Year group

Reason for referral (e.g., risk of exclusion, poor attendance, SEMH needs, SEND)

Previous alternative provision placements (if any)

Attendance record summary (optional)

IDENTIFIED NEEDS AND CHALLENGES

Behavioural concerns

Social/emotional needs

Learning difficulties / SEND / EHCP status

Mental health considerations

English language needs (for displaced learners)

Other relevant information (family circumstances, safeguarding alerts, etc.)

STRENGTHS AND INTERESTS

Hobbies and talents

Interest in music, media, tech (tick boxes for music production, DJ, podcasting, filming, digital media, etc.)

Aspirations for the future

SUPPORT REQUIREMENTS

Any known triggers / strategies that work

Required 1:1 or small group support

Communication needs

Access requirements (mobility, sensory, etc.)

RISK ASSESSMENT

Known safeguarding concerns

Medical conditions / allergies

History of aggression / absconding

Other risks (e.g., self-harm, substance use)

CONSENT

Parent/guardian consent.

Consent to share information between agencies

Photo/video consent for project documentation (optional)