CEO CSCS Referral Form

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CEO CSCS Referral Form

For the Health and Safety and CSCS short course (16+)

Email *

Key Information

Please complete this information IN FULL.

Young person's full legal name *

Young person's age *

16-19

19-25 (SEND)

Is the young person NEET (Not in Employment, Education or Training)? *

Yes

Young person's preferred name

Young person's sex *

Male

Female

Young person's gender identity

Date of Birth *

YYYY

Ethnicity (for statistical purposes)

Full address (including post code) *

Young person's contact telephone number

Parent/carer (relationship) contact telephone number *

Emergency contact name, relationship and contact details *

Young person's email address (This is necessary for registration with the awarding body.) *

Parent/carer (relationship) email address

Referring School / Agency (e.g. YOS, Employability & Skills team, Children’s Society etc.)

Referring agency's and referrer's name and contact details (telephone, email)

Case Worker's name contact details (telephone, email)

Is the young person a Looked After Child (LAC)?

Yes

Clear selection

Cultural / religious needs

Current qualifications

Important Privacy Notice

By signing below you are giving consent to Construction and Engineering Opportunities (CEO) processing the information contained on this form for the purposes of deciding whether to offer you a place at CEO and enrolling you at CEO and with various Awarding Bodies. By signing, you are also consenting to CEO contacting your school, college, parent/carer, youth worker/YOT worker or other agency for further information, where necessary. Our full policy on how your data is used, stored and destroyed is available on request.

Referral date

YYYY

Young person's signature

Special Educational Needs and Disabilities (SEND)

Please give details.

Does the young person have any of the following conditions? *

Neuro-diverse conditions (ADHD, Autism etc). If so, does the young person require medication to manage?

Cognitive issues

Speech, language and communication needs

Sensory impairment

Physical impairment

Moderate learning disability

Any other special educational needs and disabilities

Any physical disabilities (please give details below)

None of the above

Other:

Required

Please give details

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