Referring for Numeracy & Literacy Support at The ClementJames Centre

Thank you for taking the time to fill out this referral form. If you need support filling out this form, please contact reception@clementjames.org or give us a call on 020 7221 8810.

The Numeracy and Literacy Programme offers free, intensive academic support in either maths or English for students in years 3 to 11, who are currently working below expected levels in these subjects.

Once this form is completed, these details will be added to our waiting list and a member of staff will be in touch to update you on the likely wait times for support.

Please note:

This service is in high-demand and referrals may have to be prioritised based on level of need.

Priority will be given to those who have not received support in the last academic year.

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Please see our privacy notice attached here, and tick here when you have read and agree to the terms laid out in it.

Who We Can Support

Please be aware that we can only support residents who live in or who are housed in either Kensington & Chelsea, Hammersmith & Fulham or Westminster.

Please select the borough the young person is a resident of or housed in:

We also have criteria that clients need to meet to access support. At least one of the following means that the young person is able to access support at the Centre.

Please select any of the following that apply to the young person:

Family receiving benefits

Family have a household income of less than £25,000

Living in social housing (this includes council, temporary accommodation and housing associations)

Receiving free school meals

Your Details

It is helpful for us to have your details, should we need to contact you about this referral.

Full Name

Organisation

Other:

Role

Contact Number

How will you still be working with the young person being referred to us going forward?

Can we contact you about this referral? We will only do so to discuss details relating to the referral, when such details are needed in order to best support the young person.

Please tick here if you would like to be subscribed to our mailing list to hear about future workshops, programmes, events and opportunities at The ClementJames Centre.

Young Person's Educational Information

The following information will allow us to offer appropriate support to the young person being referred. Please give as much information as possible as this information may be used to prioritise referrals.

Some of the information enables us to track the number of people in the local area engaging with ClementJames' programmes and services. Collecting this information allows us to provide these for free.

What school does the young person attend?

Which year group is the young person in?

Which subject is the young person looking for support in?

What is the highest grade that the young person has been predicted in the subject that they are looking for support in (i.e. maths or English), and what are they on track to achieve?

Which kind of support would the young person benefit from most?

Which day are they most likely to be available for sessions?

Which time are they most likely to be available for sessions?

Young Person's Educational Information Continued

Does the young person have Special Educational Needs?

Please can you provide us with more details:

Does the young person have or are they awaiting an EHCP (an education, health and care plan)?

Awaiting EHCPEHCP in place

Please can you provide us with more details:

Is the young person in a mainstream school?

Does the young person have a school attendance rate of less than 90%?

Has the young person been excluded from school or are they at a significant risk of this? (This includes permanent or temporary exclusion. Significant risk refers to a large amount of behaviour points, internal exclusions etc.)

Young person has been excludedYoung person at a high risk of exclusion

Does the young person have experience with the Youth Justice System?

Support Referral

Please give details about the young person's educational support needs. This should include details about what specific topics they need to focus on (i.e. division, spelling, comprehension etc.). It should also include any additional behavioural or learning support needs, details of incidents that have impacted on their education, and evidence of how they are working below their level:

Young Person's Details

First Name

Last Name

Date of Birth (dd/mm/yy)

Gender

Self-described gender, if known:

Post Code

Guardian Contact Details

Parent/Guardian Contact Number

Parent/Guardian Email

Please provide details of the young person's emergency contact:

Full Name

Contact Number

Submit Your Form

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