Inclusion Link Programme 2018 Referral Form
A programme to support pre-school to school transition
All sections must be completed by setting and parents/carers
No further evidence will be required to be submitted with this referral
Child’s Name: ______Gender: M / FPostcode: ______DOB: ______
Main Pre-school Provider: ______
Other Pre-school Provider: ______
Child’s First Language: ______
□Early Years SEND Top-up Funding □GRT □CLA □Refugee
Early Years SEND Top-up Funding Allocation (category and level awarded): ______
SEND Diagnosis (if known): ______
Please detail other agencies known to be involved: ______
______
______
Setting(What I would like the school to know, e.g. child’s strengths, strategies used in the setting, any concerns, any questions.)
Parent/Carer(What I would like the school to know, e.g. my child’s strengths, any concerns, any questions.)
Child’s voice(What I would like the school to know about me, e.g. my likes/dislikes and needs.)
Receiving school – Parents’/Carers’ first choice: ______
Second choice: ______Third choice: ______
How we use your information
North Somerset Council is registered with the Information Commissioner’s Office for the purposes of processing personal data.The council can be contacted at 01934 888 888.
We collect the personal information on this form in order to deliver the transition Inclusion Link Programme for individual children. We store the data electronically. We use the data to organise the transition workshops where we allocate time for transfer discussions. Supporting individual children at times of transition is recommended in the Early Years Foundation Stage statutory framework (2017) and Special Educational Needs and Disabilities Code of Practice 0-25 years (2015).
In order to evaluate the effectiveness of the Inclusion Link Programme, generic statistical data (not individual data) will be analysed and shared on the North Somerset Local Offer.
Information sharing
Accessing the Inclusion Link Programme is entirely voluntary, but in order to deliver the service and monitor the effectiveness of the Programme, the Early Years and Childcare Service at North Somerset Council will share information specified above with relevant professionals involved with the child and workshop facilitators, receiving schools/academies and MAISEY professionals.
Everyone who works with children has a responsibility for keeping them safe. We may need to share information with relevant professionals where there is legal basis for us to do so (Working Together to Safeguard Children guidance (2015)).
You can learn more about how and when we share your personal data on our website at
Your consent/permission
By ticking this box, I agree that the information provided on the Link referral form can be used as outlined above.
By ticking this box,I understand that the information provided on the Link referral form will be shared with other professionals as outlined above for the purposes stated.
Withdrawing consent/permission
I understand that my consent is able to be withdrawn at any time by contacting the Early Years and Childcare Service on 01275 888 300.
Signature PRINT NAME DateKey person: ______
INCCO: ______
Setting’s email address: ______
Parent/Carer: ______
Please post your completed form to:
Stana Dimopoulos, Early Years Support Advisor, Early Years and Childcare Service, People and Communities – CYPS, North Somerset Council, Post Point 4, Town Hall, Walliscote Grove Road, Weston-super-Mare, BS23 1UJ by Friday 6 April 2018.
Alternatively, you can return your completed form to Castlewood in Clevedon by arrangement with Stana Dimopoulos, Early Years Support Advisor, Telephone: 01275 888 677.
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