In support of your request, please ensure that you can evidence when you attend:

completed request including signed consent from parent/carer

Supporting school/setting documents on provision:

assess, plan, do and reviewed documents demonstrating that targeted/personalised support has been provided

evidence of assessments/interventions -pre and post intervention data

detailed timetable showing evidence of the personalised support that has been provided, where 1:1 support is used, what personalised support are they providing when working with the child or young person

reports from professionals which must include the Inclusion and Intervention team member who will join you at SIF

Financial:

detailed costings and breakdowns of the delegated resource for the child or young person within the request

Progress data:

individual child or young person’s attainment data over 1 year, including evidence that school has monitored and evaluated where progress is below expected and the gap has not narrowed

The completed form should be forwarded by secure email to . Please do NOT send hard copies.

Way Forward – Dec 17

WF1

Way Forward

PUPIL DATA

Pupil details
Full name: / Date of Birth: / Male Female
Home Address and Postcode / Telephone Number:
Home Language: / Religion:
Education Setting: (If Early Years please state which branch where applicable and telephone number): / Year Group:
Headteacher /
Contact name if Early Years setting / SENCo:
Is the pupil Looked After (LAC)? If yes, please complete the following:
LAC by which Local Authority:
Social Worker’s name:
Address details of responsible Authority: / Telephone:
Email:
Primary Area of Need
Cognition and Learning / Communication and Interaction
Social, Emotional and Mental Health / Sensory and/ or Physical

Please continue overleaf

Parent/Carer 1
Title: / Forename: / Surname:
Address and postcode:
Preferred Contact numbers:
Email:
Home Language:
*Parental Responsibility? / Yes No
Relationship to pupil / MotherFoster carer
FatherOther – please state:
Parent/Carer 2
Title: / Forename: / Surname:
Address and postcode:
Preferred Contact numbers:
Email:
Home Language:
*Parental Responsibility? / Yes No
Relationship to pupil: / MotherFoster carer
FatherOther – please state:
Comments
Additional details
Is either parent a member of the Armed Forces? / Yes No

* Please Note: paperwork will only be sent to Parent/Carers with parental responsibility.

WF3

PARENT CONSENT FORM

To be completed by the persons with parental responsibility

Pupil’s name: / D.O.B:

I agreethat my child’s school can discuss my child’s special educational needs at the Inclusion Support and Challenge Forum so that next steps can be agreed in order to meet those needs.

I agree with my child’s information being shared and discussed at the Inclusion Support and Challenge Forum.

Signature: ______Date: ______

Print Name: ______

Relationship to child: ______

Way Forward – Dec 17