Learning Service Referral Form

Before Making a Referral

Please ensure you are using a recent version of Google Chrome or Mozilla Firefox before starting your referral as some versions of Internet Explorer are known to cause trouble in submitting this form.

To ensure each young person has an equal opportunity of getting a place with iScoil, it is important that each referral application has as much detail as possible.

After this page is submitted, the referral information will go directly into our database through encrypted means and you will have the opportunity to submit any relevant documentation.

You will receive an email acknowledgement of your referral within two working days.

For more information please visit our Privacy Policy or call iScoil on 01 4537570 if you require any assistance.

Young Person Information

  • County:
  • Gender:
  • Date of Birth (in the format dd/mm/yyyy):
  • Ethnicity:
  • Language:
  • PPS Number:
  • Young Person's Interests/Hobbies:

Reason for Referral

  • Please give as much detail as possible of the reason for referral:

Parent/Guardian Details

  • Name of Parent/Guardian:
  • Relationship to Young Person:
  • Parent/Guardian Contact Number:
  • Parent/Guardian Address (if different to above):

Education Information

  • Young Person's Education Status (Please select the most appropriate answer):
  • Please give details of the most recent qualification achieved by the Young Person:
  • Does this Young Person have any Special Educational Needs? If so please give details.
  • If possible, please give details of the Young Person's future employment/education or training goals:

Health and Safety

  • Please provide any relevant medical information about the Young Person below:
  • Are there any Health and Safety issues that iScoil should be aware of?
  • Are you aware of any Child Protection or welfare concerns?

Declaration

  • Do you accept that this young person would be a suitable candidate for iScoil?
  • Referrer's Name:
  • Referrer's Position:
  • Referrer's Agency:
  • Referrer's Phone Number:
  • Referrer's Email:

On the next page, you will have the opportunity to submit any forms, documents or reports that you feel are relevant.

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