Student details

  • Person Code:

  • DOB:

  • Course

  • Achievement Tutor:

  • Contact Tel No:

  • Date:

  • Time Taken:

  • Mentor Day:

  • Start Time:

  • End Time:

Please tick appropiate box

  • Please tick appropriate box:

Prefered Communication Methods

  • Nature of learning disability/learning difficulty:

  • Support Requirements

  • Checked to EBS:

Background Information

  • Background Information: e.g. Home, any previous support (ratios/types). EAA! Previous qualifications, work experience, barriers to learning, medical/health conditions, medications etc.

Description of Support

  • External Support Networks/agencies Accessed. (Agency, Key Contact, Telephone).


  • Support Focus/Strategies (to inform Support Plan targets):

  • Skills, strengths, hobbies & Interests:

  • Future Aspirations:

Referral made by

Current Disciplinary stage

Support Recommendations

  • Support Recommendations:


  • Colour Codes:

  • Banding:

Disclosure Statement

  • I agree to this information being shared with College and with relevant outside bodies as necessary to support me.

  • Student Signature-I understand that I may lose my allocated support sessions if I do not attend support sessions regularly and notify The Point of any absence.

  • Staff Signature:

Office Use Only

  • Person to cost for:

  • Date:

  • Time taken:

  • Person to cost for:

  • Date:

  • Time Taken:

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