Thank you for accessing the iAspire Referral Form. This form should be completed by local authorities or schools wishing to make a referral on to the iAspire Programme. The person signing this form must be authorised to do so.

iAspire is able to offer highly effective, bespoke 1:1 tuition in the home, at a neutral venue or within a school setting. Where appropriate, curriculum plans, targets and student specific resources must be provided where a student is still on roll at a school. 

A child or young person can only be accepted onto the iAspire Programme following an initial Assessment Meeting. This meeting will be led by one of the Learning Academies Education Directors and must involve the student for whom the referral is being made. These meetings provide an excellent foundation for the work that will follow and enable us to fully assess the needs and perceptions of the student, their referring agency and where appropriate, the child's parent/carer.  We will use this Assessment Meeting to form a judgement as to our suitability to support the young person effectively, to review the potential learning environment and to help us match the student to a well suited tutor. 

Referrals should be sent, password protected, to Matthew Brakenbury, Education Director matthew@learningacademies.co.uk. If you are completing this online using the survey link your referral will be delivered securely upon pressing submit. Thank you. 

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* 1. We take the security and privacy of your data seriously and strive to act in full accordance with the General Data Protection Regulations. (GDPR). Full details of our compliance and your rights in relation to this data can be found in our Privacy Policy at the bottom of our website. In addition a copy of our Privacy Policy is available upon request from info@learningacademies.co.uk.  By completing this referral form you are confirming you agreement to the statements provided. If you are not able to answer yes to all three statements then please do not complete this form.  I confirm that:

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* 2. Referrer Details

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* 3. Student Details

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* 4. Reason for referral - please provide as much detail as possible.

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* 5. iAspire Intervention Required

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* 6. Student Availability. Please be as flexible as possible.

  Monday Tuesday Wednesday Thursday Friday Saturday
AM
Lunch Time
PM
After School
Weekend

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* 7. Student behaviour at school

Unacceptable Exemplary
i We adjusted the number you entered based on the slider’s scale.

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* 8. Student Behaviour at Home (if known)

Unacceptable Exemplary
i We adjusted the number you entered based on the slider’s scale.

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* 9. Student Attendance when they are/were at school

Unacceptable Exemplary
i We adjusted the number you entered based on the slider’s scale.

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* 10. Academic Ability

Significantly below expected Significantly above expected
i We adjusted the number you entered based on the slider’s scale.

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* 11. Student Confidence

No Confidence Extremely Confident
i We adjusted the number you entered based on the slider’s scale.

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* 12. Student Resilience

No Resilience Excellent Resilience
i We adjusted the number you entered based on the slider’s scale.

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* 13. Ability to Engage Positively with Adults

Student finds it impossible to work with adults in authority Works effectively with adults in authority at all times
i We adjusted the number you entered based on the slider’s scale.

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* 14. Ability to Engage Positively with Peers

Student finds it impossible to work with others Works effectively with others at all times
i We adjusted the number you entered based on the slider’s scale.

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* 15. Please detail any known risk factors associated with this student and/or their family (e.g. history of violence, drug use)

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* 16. Any other relevant information you wish to share

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