ALL ROUNDER PROJECT

REFERRAL FORM

Mentoring, Intervention & Youth Support Services (Ages 11–18)

YOUNG PERSON DETAILS

Full Name

Date of Birth

Age

School / Setting

Year Group

UPN (if known)

FAMILY / CARE INFORMATION

Parent / Carer Name

Contact Number

Address

REFERRER DETAILS

Name

Role (e.g. DSL, SENCO, Social Worker)

Organisation

Contact Number

Email

REASON FOR REFERRAL (tick all that apply)

Risk of exclusion / excluded from schoolPoor attendance / disengagementBehaviour concernsEmotional / mental health concernsTrauma / adverse childhood experiences (ACEs)Child Criminal Exploitation (CCE) riskCounty Lines risk / gang association concernsSubstance misuse concernsLow self-esteem / confidence issuesFamily instability / safeguarding concernsAt risk of NEET (Not in Education, Employment or Training)

Other:

KEY CONCERNS (brief description)

Please provide a short summary of current concerns:

EDUCATION INFORMATION

Current attendance level (approx) %

Behaviour record summary:

Current support in place (EHCP, pastoral, etc):

SAFEGUARDING INFORMATION

Are there any current safeguarding concerns?
YesNo

If yes, please provide brief details:

Is the young person known to:
Early HelpSocial CareMASH referralYouth JusticeNone known

WHAT SUPPORT IS BEING REQUESTED?

1:1 MentoringEarly Intervention SupportBehaviour & Engagement SupportTrauma-Informed MentoringHigh-Risk Intervention SupportTransition SupportFamily Support

CONSENT (if applicable)

Has consent been obtained from parent/carer?
YesNoNot required (safeguarding referral)

SUBMISSION

Please send completed referrals to:

Email: info@allrounderproject.co.uk

Organisation: All Rounder Project

WHAT HAPPENS NEXT

1. Referral is received and reviewed

2. Initial risk and needs assessment completed

3. Mentor allocation (based on need and risk level)

4. Support plan created

5. Sessions begin

6. Regular updates provided to referrer

SAFEGUARDING STATEMENT

All Rounder Project is committed to safeguarding and promoting the welfare of children and young people. All concerns will be handled in line with Keeping Children Safe in Education (KCSIE) and relevant safeguarding legislation.

FINAL NOTE

Early intervention can significantly improve outcomes for young people. Please refer as early as possible when concerns arise.