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ALTERNATIVE PROVISION

Funding

Funding Requirements

– Aged 16-18
– Do you hold a degree?
– Are you currently in Education?
– What is your employment status?

If you are aged 19 and have an EHCP you are eligible

Apply Now

SCHOOL REFERRAL

School & Local Authority Referral Application Form

You are completing an application for an alternative provision course with AAX Academy in collaboration with LB Hounslow. Please ensure the information you enter below is correct and up-to-date.

School & Local Authority Referral Application Form

"*" indicates required fields

Are you currently in education ?*

Yes

What school do you attend ?*

What is Your School Year ?*

Please State Tutor & Head Teacher Name ?*

First Name*

Last Name*

Sex*

Email*

Phone*

DOB*

DD slash MM slash YYYY

Address*

Ciity*

Postal Code*

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Email*

Emergency ContactPhone*

Section 2 - Learning Support

Are you a young person looked after by your local authority?*

Yes

Are you currently in care, a care leaver or neither?*

Yes

Neither

Do you live in a hostel, residential centre or bed & breakfast accommodation?*

Yes

Do you consider yourself to have a learning difficulty, disability, or health problem?*

Yes

Please State*

Do you have a statement of educational needs or an Education, Health & Care Plan?*

Yes

Upload EHCP or Statemnt*

Max. file size: 2 GB.

Do you have a criminal conviction?*

Yes

State Conviction*

Conviction Date*

MM slash DD slash YYYY

Section 3 - Ethnicity, Residency & Immigration Status.

Ethnicity*

Nationality*

Have you been legally living in UK for the last 3 years?*

Yes

Section 4 - Safeguarding Childern, Young People & Vunreble Adults.

Are there any issues with learners from other schools?*

Yes

Please State learners issues*

Are there any Safeguarding issues we need to be aware of ?*

Yes

Please state Safeguarding issues*

Are you gang-affiliated?*

Yes

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