School and Agency Referrals - Impact Community ACADEMY

Our Philosophy

We believe that access to education is critical for young people to achieve their aspirations for a healthy and productive future.

Educational achievement supports young people to contribute their talents and passions to society.

Young people need to experience success in their endeavours and build the skills and attributes that they can carry into further training, employment, and life pathways as valued members of their communities.

Criteria

The criteria for Special Assistance Schools (SASs) in Queensland requires a student to have disengaged or be at serious risk of disengagement from mainstream schooling. Factors may include behaviour, social emotional factors, or the impact of a disability.

If needed please download the Form and fill out. All supporting documents need to be emailed to admin@impactca.qld.gov.au

Student Details

Student Legal Name/s:

Student’s Legal Surname:

Preferred Name:

Gender:

Pronoun:

Date of Birth:

Age:

Recommended Grade/Year of Entry:

Student LUI:

If known

Student USI:

If known

Referee Details

Referrer’s Name:

First

Last

Referrer’s Position:

Referring School/Organisation:

Contact Number:

Email

has disengaged School/Organisation:

In what capacity/role have you supported the young person?

Identify the area/s the student is showing evidence of disengagement at your school/context?

Comments if any

Explain how the student is disengaged or at high risk of disengaging.

Include the student’s engagement/attendance history.

In what capacity has the school supported the student, with the above?

Please list all strategies implemented and identify the effectiveness of implementation

In your view, what support would be needed to re-engage this student in education

From your understanding, why do you think Impact ACADEMY would be the right fit?

Previous School:

Date last attended:

Supporting Documents

Please attach any relevant assessment, reports, or additional relevant information/documentation regarding the needs of the students. e.g. Individual Learning Plan, Behaviour Support Plan, Safety Plan.

File Upload

Click or drag a file to this area to upload.

Supporting Documents Provided

Your Signature

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