Add Name of child here (Appendix B-Vision and Hearing)

Application for High Needs SEND top up funding

For: Early Years providers in the List of Providers (LoP) and Schools with Nursery Classes.

*PLEASE READ THE GUIDANCE NOTES BEFORE FILLING IN THIS FORM & COMPLETE ALL SECTIONS FULLY FOR BOTH NEW & REPEATED CLAIMS*

Term & Year you are applying for / Spring 2018 / Contact telephone number
Name of person submitting the claim / Email Address
(SCHOOLS ONLY)
School name / (SCHOOLS ONLY)
School Number (EEXXX)
(SCHOOLS ONLY)
Is your School an Academy or Free School? please state / (SCHOOLS ONLY)
Postcode of School
(LOP MEMBERS ONLY)
Provider or Childminder name / (LOP MEMBERS ONLY)
SEEGS number
(6 digit number)
(LOP MEMBERS ONLY)
Postcode of setting
Childs name
Childs date of birth
(e.g. 01/01/2012)
Childs current age in years & months (e.g. 3yr 4mth)
Number of FUNDED hours being claimed
(Maximum is 30 – to match free entitlement)
15 hours universal or up to 30 hours for eligible 3 and 4 year olds
Does the child have a Dual Placement with a Special School Assessment Nursery? If yes please give Special School name.
Is this child likely to need an application for a place at a Specialist Provision? Please see the guidance notes for more details.
Does this child live in Suffolk?
Please see the guidance notes for more details.
Does the child have English as an Additional Language (Yes/No)
Days child attends (please tick)
Monday / Tuesday / Wednesday / Thursday / Friday
a.m.
p.m.
Please tick one of the types of need below which is applicable to this child.
Complex needs
(Child fits descriptors 75% or more)
£23.33 Per hour / The amount that you will be paid is the hourly rate multiplied by the number of funded hours the child is attending. This will be the total amount paid for the term.
For example Complex needs (£23.33 per hour) x 10 funded hours attending per week = £233.30 total paid for the term.
Complex/severe needs
(Child fits descriptors 50/50%)
£36.67 Per hour
Severe needs
(Child fits descriptors 75% or more)
£50 Per hour
What are the Child’s specific needs which require to be supported over and above what you provide and after you have made reasonable adjustments within your existing resources? / (In no more than 50 words)
How do you meet the child’s specific needs? / (In no more than 50 words)
Does the child have a diagnosis? (You can apply for HNF without a diagnosis but this information is helpful to us.) / (In no more than 50 words)
Repeat claim:
If you claimed and received funding last term and wish to claim again please complete this box describing the impact that the funding has had for the child.

Authorisation

All requests for high needs SEN funding to be approved and authorised by the Setting Manager, Head Teacher or SENCo. Please complete below detail of the person approving this application;

Name
Job Role
Date

Completed forms

Please ensure all forms are submitted before the deadline date and that you have completed every section.

Schools and PVI providers - forms should be returned by the *NEW* secure email process to PLEASE READ THE GUIDANCE NOTES FOR INFORMATION REGARDING NEW SECURE EMAIL PROCEDURES - EGRESS SWITCH IS NO LONGER USED.

Guidance: Use the ‘My Learning Journey’ information and your knowledge of the child to plot the level of need across the categories and descriptors. It will be the distribution of needs identified in each category which will help you make a best fit judgement. Please tick/highlight the appropriate level of need.

Evidence to support your claim:

Please complete the most appropriate relevant descriptor (one only). Do not pick out all of the descriptors that apply only the most relevant descriptors in the complex or severe column. Highlighting descriptors in both columns demonstrates that the child falls in the 50/50 category and not the highest or lowest level of need.

Please also complete the following sections;

Pupil Profile Information must be completed for all Early Years [EY] pupils.

Specific and Prime Areas of EYFS Progress Tracker

Please use the terms: emerging, developing, secure to demonstrate the child’s current progress.

EYFS Tracker- Literacy

Reading / Writing
0-11m / See
Development Matters
8m – 20m
(8m -1y8m)
16m – 26m
(1y4m -2y2m)
22m – 36m
(1y10m -3y)
30m – 50m
(2y6m-4y2m)
40m – 60m
(3y6m-5y+)

EYFS Tracker- Mathematics

Numbers / Shape, space and measure
0-11m
8m – 20m
(8m -1y8m)
16m – 26m
(1y4m -2y2m)
22m – 36m
(1y10m -3y)
30m – 50m
(2y6m-4y2m)
40m – 60m
(3y6m-5y+)

EYFS Tracker - Understanding the World

People and communities / The world / Technology
0-11m
8m – 20m
(8m -1y8m)
16m – 26m
(1y4m -2y2m)
22m – 36m
(1y10m -3y)
30m – 50m
(2y6m-4y2m)
40m – 60m
(3y6m-5y+)

EYFS Tracker - Expressive Arts and Design

Exploring and using media and materials / Being imaginative
0-11m
8m – 20m
(8m -1y8m)
16m – 26m
(1y4m -2y2m)
22m – 36m
(1y10m -3y)
30m – 50m
(2y6m-4y2m)
40m – 60m
(3y6m-5y+)

EYFS Tracker - Personal, Social and Emotional Development

Making relationships / Self-confidence and self esteem / Behaviour and self-control
0-11m
8m – 20m
(8m -1y8m)
16m – 26m
(1y4m -2y2m)
22m – 36m
(1y10m -3y)
30m – 50m
(2y6m-4y2m)
40m – 60m
(3y6m-5y+)

EYFS Tracker - Physical Development

Moving and handling / Health and self-care
0-11m
8m – 20m
(8m -1y8m)
16m – 26m
(1y4m -2y2m)
22m – 36m
(1y10m -3y)
30m – 50m
(2y6m-4y2)m
40m – 60m
(3y6m-5y+)

EYFS Tracker - Communication and Language

Listening and attention / Understanding / Speaking
0-11m
8m – 20m
8m -1y8m
16m – 26m
1y4m -2y2m
22m – 36m
1y10m -3y
30m – 50m
2y6m-4y2m
40m – 60m
3y6m-5y+

Profile Information Appendix B Vision and Hearing

Complete as appropriate by circling or highlighting the statement.

VISION AND HEARING
Universal Needs / Additional Needs / Complex Needs / Severe Needs
Visual difficulties / levels of support required
Wears glasses:
-  sometimes
-  all the time
Has some visual difficulties. For example, wears a patch:
-  sometimes
-  all the time
With glasses is able to access the curriculum and can manage well in the school environment. / Has a visual impairment.
For example, near or distance vision is reduced.
Acuities of about 6/18.
Needs support to ensure full access to practical aspects of some lessons.
Needs some written materials to be produced using larger print and some modification of materials in order to ensure ease of access. / Has a significant visual impairment
Reduced near or distance vision and acuities of 6/24 to 6/48.
Has a restricted field of vision.
In school the young person needs:
-  all written work to be adapted & enlarged in order to access learning tasks;
-  support in practical lessons;
-  support to develop touch typing skills;
-  support in order to access information such as to access the whiteboard or information from a distance;
-  their own copy of information or to access IT support or equipment;
-  some training in social skills in order to further develop their understanding and / or communication skills. / Has little functional sight or is educationally blind. May be registered severely sight impaired.
Acuities are 6/60 or below.
Needs to have access to ICT in order to read and record their work.
May use Braille or other tactile methods of learning.
Adult support is required for:
- access to curriculum
- safety issues
-  social skills training
-  mobility support &
training

Pupil Profile Information Appendix B cont.…

Complete as appropriate by circling or highlighting the statement.

Universal Needs / Additional Needs / Complex Needs / Severe Needs
Hearing difficulties / levels of support required
The young person may have a mild hearing impairment.
Differentiation in the educational context is needed to meet their needs.
Access to curriculum can be given through differentiation in the classroom.
Support in developing their social skills will be delivered through regular classroom curriculum e.g. PSHE curriculum. / The young person has a diagnosis of a unilateral, mild and moderate, sensori-neural hearing loss.
Uses a hearing aid due to having a conductive hearing loss.
Most auditory information can be accessed with the use of:
-  hearing aid;
-  FM radio aid system;
-  support from a teaching assistant.
Key and subject specific vocabulary is reinforced. Repetition and altering how instructions are given is necessary in order to ensure understanding and curriculum access.
The young person needs additional reinforcement and explanation of school rules and appropriate behaviours / social skills at times. / The young person has a diagnosis indicating severe to profound hearing loss.
Their hearing loss requires hearing aids or the young person has a cochlear implant.
Most auditory information can be accessed with the use of:
-  hearing aid;
-  FM radio aid system;
-  support from a teaching assistant.
Teaching of key and subject specific vocabulary as well as curriculum differentiation required for pupil to access information in the classroom and curriculum.
Needs support to further develop social skills. Also issue re raising deaf awareness for staff and peers. / The young person has a severe to profound
hearing loss.
They use post-aural hearing aids, or has a cochlear implant.
Limited access to auditory information.
When the young person needs to listen to something at school there needs to be consideration to the acoustics within the room / environment in order for them to access information and the curriculum.
Requires sign support / For example, British Sign Language. If so, staff and peer group will need information / tuition and deaf awareness with staff and within school.
Teaching or advice / support from advisory teacher (sensory communication strand).
The young person needs support in social skill development.

Before submitting please ensure you have completed the application, EYFS tracker and appendix sections. This is required for both new and repeated claims.

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Appendix B HNF 2018 V3