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Referral Form
Please complete this form if you are referring a client to the LearningHUB e-Channel (Get SET) program.
A copy of this form will be sent to your email address for your records.
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* Indicates required question
Email
*
Your email
Referral Date:
*
MM
/
DD
/
YYYY
Client Name:
*
Your answer
Client's Email Address:
*
Your answer
Client's Phone Number:
*
Your answer
What is your client's main reason for upgrading?
*
Employment
Apprenticeship
Secondary Credit
Post Secondary
Independence
To Be Determined
Referring Agency Contact
Organization/Classroom Name:
*
Your answer
Program Type:
**If you are referring from a Contact North agency, LearningHUB practitioners will CC you on Entry, Exit and Course Assignment emails
*
Choose
Contact North - Contact Nord
EO - Action Center
EO - Apprenticeship Program - Other
EO - Apprenticeship Program - Pre-Apprenticeship Program
EO - Employment Service Provider
EO - Get SET (example: Adult Learning Centre, e-Channel, ACE)
EO - Ontario Job Bank
EO - Service Provider - Other
EO - Youth Job Connection - Summer Service Provider
EO - Youth Job Connection Service Provider
Government Services Municipal (example: Public Library)
Government Training Federal - Language Assessment/Training
Government Training Federal - Youth Employment and Skills Strategy (example: Skills Link, SEFY, Reach For Success)
Government Training Provincial - Language Assessment/Training
Government Training Provincial - Other (example: Skills Advance Ontario)
Independent Learning Centre
Language Assessment/Training - Other
Ministry of Citizenship and Immigration - Other
Ontario Bridge Training
Ontario Disability Support Program
Ontario Employment Assistance Services
Ontario Internship Program
Ontario Women's Directorate
Ontario Works
Other - structured/formal referral
Probation and Parole
Service Canada
Services for Indigenous People
Targeting, Referral and Feedback
WSIB
Contact/Teacher Name:
*
Your answer
Phone Number:
*
Your answer
Email address:
*
Your answer
Is there any other information you would like to share about this referral?
*
Your answer
Client Consent
I consent to and authorize the release and disclosure of information between the agencies indicated on this form. I acknowledge that the referring service provider may be notified once I have made contact with the referred service agency.
*
Yes
No
Client Name:
*
Your answer
Date:
*
MM
/
DD
/
YYYY
Next Step
*
I will help my client register for the LearningHUB.
https://amdsb-intake-hub.escases.ca/
Please send my client registration instructions.
I will/have sent the learners registration information to
registration.learninghub@ed.amdsb.ca
*If you send the registration information please black out the SIN and we will reach out to the learner to get this information.
Assessments
*
I am sending a recently completed assessment.
I do not have a current assessment, but I am sending their previous one as I feel it is still an accurate depiction of their level.
I do not have a current assessment. Please assess my client.
Are you referring from a classroom Get SET program?
*
Yes
No
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