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This form is to be used by professionals seeking to refer a young person to Full Circle Education for a ‘Short Term Exclusion
Referral’. By signing this document, you are committed to funding the duration of the placement. The follow process must be
adhered to in order to negotiate and secure a Short Term Exclusion placement:
1. Please contact Damon Moore (Project Manager) to explore the availability of spaces 0208 8562050/ 07834 156482
2. Complete the form below (a separate form for each student being referred) and either fax or e-mail to Damon Moore
or Angela Young at: ( FAX) 0208 8562050 / e-mail: Fullcircle.ed@btinternet.com
E-mail Address
Work Telephone: