Prime Educational Services

Parent/School Contact Information

  • Full Name -----------------------------------------------------

  • Email Address -------------------------------------------------

  • Phone Number -----------------------------------------------

  • Relationship to Child

    • Parent

    • Guardian

    • School Representative

  • School Name (if applicable) ------------------------------------

  • Location (City / Emirate) -------------------------------------

SECTION 2 — Learner Information

  • Child’s Full Name ------------------------

  • Child’s Age ----------------------------------

  • Gender --------------------------------------

  • Current School ----------------------------

  • Grade Level --------------------------------

SECTION 3 — Support Needs

Type of Support Required

(Checkboxes)

  • Academic Support

  • Behavioural Support

  • SEN Support (ASD, ADHD, Learning Difficulties)

  • Social/Communication Support

  • Classroom Shadowing

  • Homework Support

  • Mixed Support

Diagnosis (Optional)

  • Autism (ASD)

  • ADHD

  • Learning Difficulty

  • Speech Delay

  • Behavioural Challenges

  • Not Diagnosed / Under Assessment

Upload Any Reports (Optional)

  • Educational Psychologist Report

  • Medical Report

  • IEP / School Report

  • Behaviour Plan

  • Child’s Full Name ------------------------

  • Child’s Age ----------------------------------

  • Gender --------------------------------------

  • Current School ----------------------------

  • Grade Level --------------------------------

🌟 SECTION 4 — Required Schedule

    • Preferred Start Date

      • Date picker

      Hours Needed Per Day

      • 1–2 hours

      • 3–4 hours

      • 5+ hours

      • Full school day

      Days Needed Per Week

      • 1–2 days

      • 3–4 days

      • 5 days

      Duration of Support

      • Short‑term (1–3 months)

      • Medium‑term (3–6 months)

      • Long‑term (6–12 months)

      • Full academic year

SECTION 5 — Additional Details

  • Describe the child’s strengths. ---------------------------------------------------------------------------------------

  • Describe the child’s challenges. -------------------------------------------------------------------------------------

  • Any triggers or behaviours we should be aware of ----------------------------------------------------------

  • Any strategies that have worked well in the past --------------------------------------------------------------

    • Child’s Strengths ---------------------------------------------------------------------------------------------------

    • Child’s Challenges --------------------------------------------------------------------------------------------------

    • Any triggers or behaviours we should be aware of -----------------------------------------------------

    • Strategies that have worked well in the past --------------------------------------------------------------

SECTION 6 — Parent/School Requirements

  • Do you prefer a male or female LSA?

    • Male

    • Female

    • No preference

  • Do you require the LSA to have:

    • SEN training

    • Behavioural training

    • ABA experience

    • School experience

    • Bilingual ability

    • No specific requirement

    SECTION 7 — Upload Documents

    • Child’s Passport Copy

    • Child’s Emirates ID

    • Any supporting reports (IEP, medical report, assessment report)

    This helps us understand the child’s needs better.

SECTION 8 — Declaration

I confirm that the information provided is accurate and understand that this request will be reviewed by Prime Educational Services.

  • Child’s Full Name ------------------------

  • Child’s Age ----------------------------------

  • Gender --------------------------------------

  • Current School ----------------------------

  • Grade Level --------------------------------

    I agree. ----------------------------

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