online referral form

EdStart - Online Referral Form

Instructions: Please complete the form as comprehensively as possible to enable us to cater for the young persons needs. Should you need to save the page and return to it at a later stage, please save as a webpage. When you re-open the page, it will have saved any entries you made previously. Should you wish to send to other professionals to complete any of the sections, save as above and email the page as an attachment. For any other support on using the online referral form, please contact us on 0161 945 8940 or eva@edstart.org.uk
  • Personal Details

  • Referral Details

  • School Details

  • Further Information

    Please complete this section if you check any of the EDUCATIONAL STATUS boxes below
  • (if new to area)
  • CAF Information

  • (if yes)
  • Educational Information

    SATS
  • Key Stage 2
  • Key Stage 3
  • Key Stage 2
  • Key Stage 3
  • Key Stage 2
  • Key Stage 3
  • Predicted Grades (core subjects)

  • Check boxes of subjects young person is expected to achieve grades A-C or equivalent in
  • Check boxes of subjects young person is expected to achieve grades D-G or equivalent in
  • Sanctions and Exclusions

  • For this academic year to date
  • For this academic year to date
  • Attendance

  • Other Agencies Involved

  • YOS Status

  • LAC Status

  • (Please include any information on mental health, offending, level of support shown previously, or any other relevant information)
  • Reasons for Referral

  • (Should be discussed with young person)
  • Risk Assessment

    Completing the following assessments will allow us to identify the needs of the young person and manage risks associated with their behaviour. It also provides a framework to assess risks on leaving our provision, helping identify improvements made during their placement. Please chose from the options bellow (1 to 5), 1 being very unlikely and 5 being very likely
  • Aggression and Violence in School

  • (Specify from above)
  • School Community Interaction with staff and peers

  • (Specify from above)
  • Learning Behaviour

  • (risk of disrupting lesson)
  • (Specify from above)
  • School and Local Community Personal Contribution

  • (Specify from above)
  • Emotional Litercy

  • (Specify from above)
  • Additional Information

  • Family details, social, emotional and behavioural factors, personal health)
  • Specify vocational/ GCSE/ Functional/ Wider or Pastoral (PSHE)
  • (To be completed by the Edstart Management Team)