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BASE Learning
Program - Student Referral Process 


Please follow the steps below to submit a Student Referral to the program.


1. Call the RSSP main office at 847-872-1900 to discuss the student's placement and confirm availability.


2. The following information will be required:

  • Student’s Emergency Contact Information

  • School physical & immunization record (6th or 9th grade) (Optional)

  • Reason for referral

  • Free / Reduced Lunch Form – Downloadable Form here (Optional)

  • Academic Instructional Guide / Materials: If the student will be bringing their academic materials, please provide a list of the subjects and/or assignments the student is expected to complete. (Optional)


3. Complete the Student Referral Form.  Click the link below to complete the BASE Learning Program Student Referral form.  The "School District Liaison" and "Student Information" sections must be completed in order to "Save & Continue Later". A link to complete the referral will be sent via email to the District Liaison’s email address, which can then be forwarded as needed to other school staff to complete the referral. 


Link to BASE Learning Program Referral Form


4. Submit the Student Referral Form.  Once the referral is complete, click on the “Submit Application” button at the bottom of the page.  Once submitted you will be immediately notified at the top of the page that the referral has been submitted.  We will process the referral and contact to confirm a start date for the student. 


5. Please provide a printed copy of the BASE Learning Program Commitment Form (downloadable here) to the family.  We request that the signed copy be returned to the BASE Learning Program on the first day of the student’s attendance.  A copy of the BASE Learning Program Student Orientation Guide can be found on the website.


Please feel free to contact us with any questions/concerns at 847-872-1900.  Thank you.

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