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

  • Date of Birth (in the format dd/mm/yyyy):
  • Ethnicity:
  • Language:
  • Is this referral for a blended centre?

Parent/Guardian Details

  • Name of Parent/Guardian:
  • Relationship to Young Person:
  • Parent/Guardian Email:
  • Parent/Guardian Address:
  • Is the above parent/guardian aware of this referral?
  • Is the above parent/guardian supportive of this referral?

School History

  • School Name and Address:
  • School Contact Person's Name:
  • School Contact Person's Position:
  • School Contact Person's Email:
  • Is this a DEIS school?
  • Total days young person was absent last year:
  • Trends of absence over last academic year:
  • Previous Schools Attended (please include contact information):
  • Trends of absence in previous schools:
  • Does the young person have a school place?
  • Has the principal agreed to maintain young person on school roll should the young person request to return to school?

Describe Interventions Attempted

  • Please select the interventions attempted:
  • Home School Community Liaison
  • School Completion Programme
  • TUSLA
  • Other Interventions:
  • What resources have been allocated to meet young person’s needs?
  • Have parents engaged with any support/resources?
  • Does this child have a diagnosed Special Educational Need?
  • Has this child been assessed (or is assessment pending) by the national Educational Psychological Service?

Reason for Referral

  • Please select at least one of the following reasons for the referral:
  • Anxiety
  • Behavioural
  • School Phobia
  • Social Phobia
  • Medical (with Diagnosis)
  • Medical (without Diagnosis)
  • Other
  • Please give more details:
  • Length of time EWS is involved with child/family:
  • Efforts made to support school attendance:

Other Interventions

  • Has Home Tuition been applied for?
  • Was Home Tuition Granted?
  • Was Home Tuition Availed Of?
  • Please evaluate the Home Tuition:

Other Agencies

  • Do you have any knowledge of other agencies involved with the family?
  • Are you aware of any Child Protection or welfare concerns?

Medical Information

  • Please provide any relevant medical information about the young person below:

Other Relevant Information

  • Are there any Health and Safety issues that iScoil should be aware of?
  • Does the young person have access to the following technology? Give as much detail as possible and specify if the internet connection is broadband, mobile broadband etc.
  • Please note that tablets are not considered a suitable means for a young person to access iScoil:
  • Internet Connection?
  • PC?
  • Laptop?

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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