Alternative Provision Referral

A straightforward referral for schools and commissioners. Please provide the information we need to consider the placement, plan appropriate support and keep the pupil safe.

Pupil & school details

Fields marked * are required.

Pupil name *Date of birth * Year group *UPN Optional at initial referral Referring school *Referrer name * Referrer email *Referrer telephone number

Placement request

Brief answers are fine. We only need information relevant to considering and planning the placement.

Preferred start dateAnticipated placement length Requested timetable / hoursPriority subjects Reason for referralWhat would a successful placement achieve?For example: re-engagement, improved attendance, curriculum access or reintegration readiness.

Support, safety & key information

Does the pupil have identified SEND? *

NoSEN SupportEHCP

What do we need to know to support the pupil?Key needs, strategies, reasonable adjustments or communication needs.

Is there any safeguarding, behaviour, medical or risk information we need before the pupil starts? *

NoYes

Relevant informationPlease include only information relevant to the safe delivery of the placement. Parent/carer nameParent/carer contact number

I confirm that, to the best of my knowledge, the information supplied is accurate and relevant to this referral.I confirm that the school is authorised to share the information required for In-Tuition Learning to consider and deliver this placement.I confirm that the parent/carer has been informed of this referral.

Review referral

Please check the information below. You can go back and amend anything before submitting.

Referral received

Thank you. Your referral has been successfully submitted to In-Tuition Learning.

We will review the information and be in touch regarding the next steps.

Please only provide information relevant to this referral. For information about how we handle information, see our policies.