Additional Support Plan

Child or Young Person’s Name
Date of birth / Gender
Unique pupil number
Year group
Parent/Carer Name
Parent/Carer Contact Details
Child or Young Person’s School
Key School Contact
Home language
CLA/Other Circumstances
Pupil Premium child
Home address
Post Code
Child or Young Person’s Photograph (optional)
Plan Number / Plan Start Date / Review Date

Please list all persons involved (add more if needed)

Name / Designation / Written report provided (Y/N)

The following documents should accompany this paperwork (please indicate if attached, Y/N):

Pupil’s views documentation/
One page profile (PCP must be included) / Parent/Carer views documentation
School Info:
(Including attainments, attendance, any exclusions, see appendix 1) / Please list any other reports or involvement from professionals received and attached:
Eg (Child protection, TAF, ASC, SALT, Outreach, see appendix 1)

Aspirations – What is important?

Child’s or Young Person’s Aspirations
Short Term / Long Term
Parent/Carer’s Aspirations
Short Term / Long Term
School/Setting’s Aspirations
Short Term / Long Term

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Aspirations to Outcomes

The outcomes should describe the specific things the child/young person will gain or develop to help them work towards their aspirations.

Short term outcomes (One year or less) (Add more rows if needed)

Agreed outcomes / Suggested solutions to meet outcomes / By when / How will we know when it’s achieved?

Long term outcomes (By the end of key stage or longer) (Add more rows if needed)

Agreed outcomes / Suggested solutions to meet outcomes / By when / How will we know when it’s achieved?

The needs of the child or young person in relation to the code of practice.

Identified Needs (describe) / Areas of strength and key skills
Cognition and Learning
Communication and Interaction
Sensory/Physical
Social, Emotional and Mental Health

Child or Young Person’s health needs – if appropriate (Please give details of any medical diagnosis)

Summary of health needs:
Impact on education / Agencies and/or facilities to meet need / Outcomes

Child or Young Person’s care needs – if appropriate (Attendance, social relationships, home circumstances, etc)

Summary of care needs:
Impact on education / Agencies and/or facilities to meet need / Outcomes

Provision Map (What additional provision has the school put in place to support the child/young person’s outcomes?) (Add more rows if needed)

Outcomes / Support and frequency / Dates
(Start finish) / Cost
(Best estimate) / Why outcomes met/not met (complete at review)?

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Basic Skills Achievements
Early Years Foundation Stage Profile Data (Good Level of Development)
Attainment
2 years ago / 1 year ago / Current
Yr Group / Level / Yr Group / Level / Yr Group / Level
Reading
Writing
Number
Science
Standardised test results. It is your results that we are interested in here and they only need to be included if this type of testing is part of your usual practice and the scores are not evidenced elsewhere in external agency reports. Please use the last two scores available, it is not necessary to retest for the purpose of this submission.
Skill tested / Test Used / Date Tested / St Sc / Date tested / St SC
Reading accuracy
Reading comprehension
Reading fluency
Spelling
Number
Handwriting speed
Other

This page to be further reviewed by secondary head teachers

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Agreement Plan
Plan completed by / Name: / Date:
Child/Young Person Declaration / I agree that this information about me may be shared with other people. / Name: / Date:
Signature:
Head Teacher Declaration / I agree that this is a true representation of the pupil’s history. / Name: / Date:
Signature:
Parent Declaration / I agree that this is a true representation of my child’s history and agree that it may be shared with other professionals as approriate. / Name: / Date:
Signature:
Any Other Relevant Signatory / Name: / Date:
Signature:

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