Induction Form & Home Tuition Contract

(For office use – Please ensure ALL boxes are completed at Induction meeting)

Interview Date* Attended By* Email Address of Attendee – A copy of this form will be sent to this address.*

STUDENT DETAILS

	Legal First Name	Legal Last Name	Gender	Date of Birth	Country of Birth	Nationality	Home Language	First Language spoken by student

Ethnicity


Other (Please specify)

	Religion	Home Language	First Language Spoken By Student	Student Mobile	Student Email Address	Address Of Student	Post Code

FAMILY GUARDIAN AND KEY CONTACTS - PRIORITY ORDER

1st Family, Guardians and Contacts/List by priority
	Title	Legal First Name	Legal Last Name	Relationship	Mobile Number	Email Address

	Home Landline Number	Work Number	Parent/Carer Address	Post Code	Moved In Date

Please SelectLegal GuardianPrimary GuardianAuthorised To Collect

2nd Family, Guardians and Contacts/List by priority
	Title	Legal First Name	Legal Last Name	Relationship	Mobile Number	Email Address

	Home Landline Number	Work Number	Parent/Carer Address	Post code	Moved In Date

Please SelectLegal GuardianPrimary GuardianAuthorised To Collect

Home BroadbandYesNo

Parent/Carer In The Armed ForcesYesNo

Social Worker
	Name	Contact details	Email address


Looked After (In Care) - Home Local Authority

Have you applied for FSM?YesNo

MEDICAL DETAILS

Medical
	NHS Number	Medical Surgery Address and contact details	GP Name	Current Medication	Medical Notes


Other (give details)

Referred by
	Name	Contact number	Email

Date of Referral

EDUCATION INFORMATION

Education History
	Previous School Name	Entry Date	Leaving Date	Current Year Group

Still on school rollYesNo

Special Educational Needs (SEN) Information

SEN Status
	Education, Health and Care Plan	From Date	Until Date	Notes

	SEN Support	From Date	Until Date	Notes

	Monitoring	From Date	Until Date	Notes

Educational Needs - Specify Type - Dates From - Until
	Type	From Date	Until Date	Notes

	Type	From Date	Until Date	Notes

Student Views: Subjects & Interests

Student's perception of
	Best/Easiest subjects	Worst/Hardest subjects	Strengths	Weaknesses	Difficulties Inside Class	Difficulties Outside Class

Please rate the following
	Hobbies/Interest	School activities/Clubs/Teams	Possible Future plans	Parent perception of the above

HOME TUITION CONTRACT

	Student's Mobile	Student's Email	Number of hours per week	A suitable location for tuition with table and chair

Date tuition to commence

Please selectParents / Carers permission ( So that we may share important information about their child's needs across agencies )Health & Safety Points:Responsible adult over 18 on siteMobile, TV, Any Entertainment must be switched offInform Tutor/Office ASAP if cancelling lesson. Office No: 0208 353 4170

Please Upload Supporting Documents No file chosen Signed: Parent/Carer :* Signed: Student: Signed:*

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