Form CF2

Consultation Request Form (Parents/Carers Views)

Educational Psychology Service

  1. Languages spoken at home
  1. What does your child like to do at home? Does (s)he have any particular hobbies and skills?
  1. Family: Position in family, ages and schools of brothers and sisters. Please give the languages spoken at home.
  1. How do you feel about your child’s progress at school and the help (s)he has been offered?
  1. What are your concerns about your child, and how long have you been concerned?
  1. What have you been able to do to help?
  1. Have any other agencies been involved with your child (e.g. clinic, speech therapist)?
  1. What does your child tell you about school?

The Educational Psychologist will be pleased to meet with you and anyone else you want to accompany you. It is usual for the school to arrange such an appointment, at a mutually convenient time.

Parent’s / carer’s Signature: ______Date: ______

ETHNICITY
/
Tick
WHITE
English
Scottish
Welsh
Other White British
Irish
Irish Traveller
Albanian
Bosnian Herzegovinian
Croatian
Greek or Greek Cypriot
Greek
Greek Cypriot
Italian
Kosovan
Portuguese
Roma / Roma Gypsy
Serbian / Yugoslavian
Turkish or Turkish Cypriot
Turkish
Turkish Cypriot
White European
White Eastern European
White Western European
White Other
Any Other White Background

MIXED / DUAL BACKGROUND

White & Black Caribbean
White & Black African
White & Asian
White & Chinese
White & any other group
Asian & Black
Asian & Chinese
Asian & any other group
Black & Chinese
Black & any other group
Chinese & any other group
Other mixed background
Any Other Mixed Background

ASIAN

Indian
Mirpuri Pakistani
Other Pakistani
Bangladeshi
African Asian
Kashmiri
Nepali
Sinhalese
Sri Lankan Tamil
Any other Asian Background
ETHNICITY
/
Tick
BLACK
Black Caribbean background
Black Angolan
Black Congolese
Black Ghanaian
Black Nigerian
Black Sierra Leonian
Black Somali
Black Sudanese
Other Black African
Black European
Black North American
Other Black
African
Any Other Black Background

CHINESE

Chinese
Hong Kong Chinese
Malaysian Chinese
Singaporean Chinese
Taiwanese
Other Chinese
ANY OTHER ETHNIC GROUP
Afghani
Arab Other
Egyptian
Filipino
Iranian
Iraqi
Japanese
Korean
Kurdish
Latin/South/Central American
Lebanese
Libyan
Malay
Moroccan
Polynesian
Thai
Vietnamese
Yemeni
Any Other Ethnic Group
Refused
Information Not Obtained