Brain in Hand

Brain in Hand Support Package

First year of study for licence start date*

Anticipated final year of study for subscription end date*

Quote Required*

Full Support Packages include Specialist Coaching and connection to a Brain in Hand Response Service for the length of the subscription. Full Renewal Packages include both software and Response Service connection.

Independence Support Packages include Specialist Coaching and connection to a Brain in Hand Response Service for the first 120 days, to support transition. Independence Renewal packages contain software subscriptions only.

Please choose this option where the student already has a software subscription but wishes to add Specialist Coaching.

Please choose this option where the student already has a software subscription but wishes to add connection to a Brain in Hand Response Service.

Please note, this quote does not include Brain in Hand Specialist Coaching, which is to be quoted separately and delivered by an Approved Brain in Hand Specialist.

Please specify who will be delivering the Specialist Coaching for this student*

This must be an Approved Brain in Hand Specialist.

Please specify who will be supplying the Software Subscription for this student*

We will then ensure we match the Specialist Coaching to the correct licence.

Would you like us to send an invoice based on this quote request?

We can start the process straight away by raising an invoice and sending it to you based on this referral information OR we can wait until you have confirmed you are happy with the quote and request an invoice by email or Purchase Order.

Please tick to confirm you have checked that the candidate has, or is willing to purchase, a compatible smartphone or tablet device.*

The free Brain in Hand app can be downloaded from the Apple App Store onto iOS devices (version 8+) or the Google Play Store onto Android devices (version 4.0.3+). Full details can be found at www.braininhand.co.uk/student-support/.

The candidate has or is willing to purchase a compatible smartphone or tablet device

Reason for referral

This information will be used to help tailor the support package to meet the needs of the student.

Would you like to tell us more about the student?

Yes
Not now

Please identify the reason for this referral

(tick as many as are appropriate)

Please provide us with any notes about your above answer(s)

The student:

is autistic or has an autistic spectrum condition
has a mental health difficulty
has anxiety (without mental health diagnosis)
has an acquired brain injury
has a Specific Learning Difficulty
has another diagnosis or reason for using Brain in hand
I would prefer not to say

We ask this question so that we can match the student to the most appropriate Specialist Supporter and Response Service for their needs.

Please provide us with any notes about your above answer(s)

Needs Assessment

Please upload a copy of the student's needs assessment here (if appropriate)

Drop files here or

Is there anything else?

If you have any questions about Brain in Hand or the next steps, or if there is anything else you would like us to know about the student or their support, please tell us here...

HE Student Referral

Step 1 of 2

Referrer's Details

Funding for Brain in Hand

Student's Details

Brain in Hand Support Package

Reason for referral

Is there anything else?

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