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Template · Education · 6 sections

Learning Support Referral Note

Documentation for referring a student into learning support programs with background and evidence.

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Built for

  • Learning Support Teacher
  • Teacher
  • Special Education Teacher
  • Year Level Coordinator

Find it on the templates page

6 sections

Template structure

The learning support referral note template captures these sections automatically from your recording when your school has added AI. With AI off, staff fill in the sections themselves.

  1. 1 Student Details
  2. 2 Referral Reason
  3. 3 Background
  4. 4 Assessments
  5. 5 Strategies Tried
  6. 6 Recommendations

The Learning Support Referral Note template

LEARNING SUPPORT REFERRAL

STUDENT DETAILS:

Name:

Year/Grade:

Class Teacher:

Date:

Referred By:

REFERRAL REASON:

( ) Reading below expected level

( ) Writing difficulties

( ) Numeracy difficulties

( ) Oral language concerns

( ) Executive functioning

( ) Other: ___

BACKGROUND:

[Brief student history, previous support, family context if relevant]

CURRENT PERFORMANCE:

Reading Level:

Writing Level:

Numeracy Level:

Compared to Expected Level:

ASSESSMENT DATA:

Assessment | Date | Result | Expected

[e.g., PAT Reading, Running Records, NAPLAN, school-based assessments]

STRATEGIES ALREADY TRIED IN CLASSROOM:

[What the classroom teacher has implemented]

1.

2.

3.

Duration of Strategies:

Effectiveness:

PARENT/CARER AWARENESS:

( ) Informed ( ) Meeting held ( ) Not yet informed

Details:

The opening of the template: its headings and fields.

How it works

  1. 1

    Record or dictate the meeting

    In the room or over a video call. Audio is deleted once transcribed. If a recording can't upload or be transcribed, it stays on your device so you can try again.

  2. 2

    Pick the Learning Support Referral Note template

    When you record, dictate or upload, press the Note template button, search by name or section, and open Sections to preview it. Make it your default at this school so it is ready next time. You can switch templates until you submit the recording.

  3. 3

    Review and finalise

    Your note is generated in the structure above. Edit anything you want — in your school’s words — then save to the student’s record.

Quick guide

Which template should I use?

Start from what just happened. You can switch templates until you submit the recording.

More education templates

IEP/ILP Progress Note Individual Education/Learning Plan progress note documenting goal achievement and adjustments. Read → Curriculum Differentiation Documentation of how curriculum has been adjusted for an individual student — content, process, product, or environment differentiation — with the rationale, the strategies in place, and how their effectiveness will be reviewed. Useful evidence for NCCD, IEPs, and learning support team meetings. Read → NCCD Evidence Record Evidence record for the Nationally Consistent Collection of Data on School Students with Disability (NCCD). Captures the adjustments provided across categories (curriculum, environment, communication, personal care) and the evidence base sustaining each, with the disability category and level of adjustment left for the school team to decide — built for census-time review and audit. Read → Intervention Session Note Session note for literacy, numeracy, or other targeted learning interventions (1:1 or small group). Read → Structured Reading Intervention Session Session note for structured literacy and reading intervention programs (1:1 or small group). Read → Classroom observation record for school staff Structured classroom observation capturing the context of the lesson, the student's engagement and behaviour over time, peer interactions, work output, environmental factors, and a brief interpretation. Suits learning-support, wellbeing, and behaviour referrals as the evidence base for next-step planning. Read →
Browse all education templates

Guides for this kind of note

School Counsellor Documentation Best Practices in Australia Read → Session Notes vs Case Notes for Education Professionals Read → Wellbeing Screening Protocols in Australian Schools: A Documentation Guide Read →
All guides on Disability Inclusion / NCCD

Try the Learning Support Referral Note template free

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  • Made-up students only: no real student information needed

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