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Progress School & Progress Care and Education Ltd - Call us on 01772 623333

Pupil Referral

Please provide us with the following basic information about the pupil and we will be in touch to discuss the pupil's needs with you in more detail.

Pupil Referral Enquiry
Name of referring person		*
Relationship to child		*
Contact telephone number		*
Pupil Details
Name of pupil
Age of pupil
Diagnosis (eg Autism)
Level of learning difficulty	Mild Moderate Severe
Additional needs
Additional Details
Local Education Authority
Current Placement
Reason for Referral
Submit Referral

All information will be directed to the Principal and treated with the strictest confidence and not released to any other party.

Progress Care & Education Ltd
Suites 1 - 5 Centurion House, Centurion Way, Leyland, Lancashire, PR25 3GR
t: 01772 623333
f: 01772 623339
e: info@progressschool.co.uk

Registered Office: Suites 1 - 5 Centurion House, Centurion Way, Leyland, Lancashire, PR25 3GR • Registered Number: PAS 3545816, PCE 3162312 • Registered in England