Request for Statutory Assessment of
Special Educational Need
Primary and Secondary
Pupil’s name:Date of birth: / Child’s UPN: / Year group:
School:
Signature of Headteacher: / Date:
The following materials have been designed to assist in the collection of the evidence required when considering a statutory assessment. This pro forma should be completed and sent to the local SEN office c/o the Locality Casework Manager. Receipt of the completed information will be considered as the starting point for the request for statutory assessment.
Contents
Page 1 / IntroductionPage 2 / Instructions and checklist Completion of Evidence and Attachments
Pages 3 – 6 / Section 1 / – / To be competed for ALL pupils
Pages 7 – 8 / Section 2 / – / To be completed for ALL pupils
Page 9 / Section 3 / – / To be completed for pupils with behaviour, emotional and social needs
Page 10 / Section 4 / – / To be completed for pupils with physical and/or
sensory Needs
Instructions and reminders for completion of evidence
Actions / Completed?Complete Section 1 and 2 for all pupils
Complete Section 3 and 4 where relevant
Items / Attached?
The three most recent Individual Education Plans (IEP), Individual Plans (IP) and/or Provision Maps and records of regular reviews
The two most recent Educational Psychologist’s visit summaries
Other agencies’ reports, e.g. from specialist teachers, speech therapists, child and family support workers
Evidence of curriculum differentiation/classroom access (if not evident
from IEP/IP)
Two annotated examples of the pupil’s work (see Page 6)
A completed Speech and Language Framework Profile (p53 App.B of the SALF document) for pupils with speech and language difficulties
This should have been completed in liaison with a speech and language therapist, a specialist teacher and/or an educational psychologist.
‘My Views’ document recording the pupil’s views gathered using their usual means of communication.
Parents’ views if not recorded in reviews of IEPs/IPs/Provision maps?
Data on the performance of the cohort in which the pupils working e.g. Target Tracker or similar.
Other supporting evidence – please specify
e.g. further information re. behavioural difficulties and/or physical/sensory needs where relevant, as specified in sections 3 and 4; Section 251 8TN Notional Budget.
Section 1 – to be completed for all pupils
(a) Pupil and school details
(i) / Pupil’s name:
Date of birth:
Chronological age: / years / months / Current NC year:
Gender: / MaleFemale / DfE Category of need:
(ii) / Father/carer’s name:
Address:
Postcode: / Telephone no:
Mother/carer’s name:
Address (if different from father’s):
Postcode: / Telephone no:
Is the pupil looked after by the local authority? / Yes No
(iii) / School name: / DfE no. 881/
SEN Admin area: / Mid / North East / West / South
(iv) / Please give the date(s) when this request and evidence were discussed with:
a)EP: / Name of EP:
b)Parent/carer:
Is the pupil’s attendance at school satisfactory? / Yes No
Has the pupil been excluded from school? / Yes No
Section 1 continued – to be completed for all pupils
If yes state whether fixed term or permanent with date:
(b) Type of Special Educational Need
Type of need / Main area of difficulty (check one box only) / Other area(s) or difficulty (check as relevant)
Cognition and learning
Behaviour, emotional and social difficulty
Communication and interaction
Sensory and/or physical
(c) Essex School Action Plus records
(i) / Date of initiation of Essex School Action Plus.
(ii) / Dates of IEPs/IPSs/Provision maps in past 12 months.
(iii) / Dates of Reviews in past 12 months.
(Remember to attach copies of the three most recent IEPs/IPs/PMs and review records)
(d) EP involvement
Date school last consulted with EP regarding intervention:
(Remember to attach the most recent summaries relating to this pupil)
(e) The involvement of outside agencies (other than the EP)
Indicate which agencies have been involved over the past twelve month period and attach the most recent reports that have been used to inform individual planning.
Agency / Dates of involvement / Most recent report attached
Yes No
Yes No
Yes No
Yes No
(f) Curriculum differentiation/classroom access
(i) / Provide evidence that the school has taken action to ensure appropriate curriculum differentiation/classroom access for this pupil in line with “Inclusion: providing effective opportunities for all children”. (Appendix 2) It is not necessary to provideadditional evidence if this is available in the provision map or other individual plans. If it is not available, please attach the evidence for this from teachers’ plans/records.
Evidence available in individual plans? / Yes No
Other evidence attached? / Yes No
(ii) / Attach two examples of the pupil’s work. This may be in English, Maths or another area produced during the week previous to the completion of this document. Each piece of work should be annotated briefly to indicate:
The aim of the activity, the task set, support (if any) and time taken to complete
the activity.
(g)Current support arrangements
Please note this does not need to be completed if already available in attached provision map or individual plan.
Support / Purpose / From (role) / Time (per week)
Individual
Small group
Whole class
Whole school
(h) School’s SEN delegated budget
as shown on the School’s Budget Share Section 52 that can be accessed on the Essex Schools Infolink > Service Areas > Finance > Budget and Funding issues if you scroll to the bottom of the centre page and select the type of school then enter your DfE number in the yellow cell before pressing Return.
The guide to SEN Funding in Essex is on the same Infolink page as this form and contains explanations of the SEN Notional Budget and on what it should be spent.
Current year’s delegated SEN Budget: / = £
Number of pupils at:
Essex School Action / =
Essex School Action Plus / =
(i) Pupil involvement and views:
See the Essex pro forma ‘My Views’ under SEN Paperwork on the Infolink to record pupil’s views and attach them to the application.
(j) Parental involvement and views:
Please give evidence of how the school has actively sought involvement of parents and the pupil and summarise their views, if not included within the current individual education plan or other planning format.
Section 2 – to be completed for all pupils
Attainment information
Name of child:
Date of birth:
Please record two sets of results of reading accuracy and spelling age assessments carried out, using the same test, over a period of the last two years.
Standardised scores
Date of test / Test used / Actual age on test date / Test score / Reading/
spelling age
Reading accuracy
Reading comprehension
Spelling
Current attainment –please indicate clearly whether levels given are:
National Curriculum (NC) orP Scale (P)
English / Maths / Science
Strand / Level / Strand / Level / Level =
Speaking / Using and applying
Listening / Number
Reading / Shape, space and measurement
Writing
Section 2 continued – to be completed for all pupils
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Personal and social developmentAttribute / Level
Interaction and working
with others
Independent and
organisational skills
Attention
Most recent end of Key Stage SATs
or Teacher Assessment results
Year group:
Date:
English / Maths / Science
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Information about other attainment and achievements:Completed by: / Designation:
Date:
N.B.
Please make sure that the name of the pupil, his/her date of birth and the date of the application are written on any additional information and accompanying evidence, then firmly attached to main the document. It goes without saying that a copy of everything should be retained and a note made of the date on which the request was sent to the SEN Area Office.
Section 3 – to be completed (where relevant) for pupils whose difficulties include behaviour, emotional and social difficulty(a)Evidence of behavioural difficulty and intervention
Where a pupil’s difficulties include behaviour, emotional and social difficulties the school will need to provide clear evidence of significant and long standing difficulties and the interventions that have been implemented and evaluated.
This information should be largely available within the individual plans and reviews attached to this request and the evidence of curriculum differentiation and access.
Schools should supplement this information with one recent piece of structured information such as an observation record, ABC record or behaviour checklist that has been used by the school at Essex School Action Plus.It would be expected that schools would have been using formats similar to those in SENCO Manual 2 or The Essex Approach: Promoting Positive Behaviour.
Indicate on the front summary if other information is attached.Please note incident logs alone are not helpful in evaluating pupils’ needs in relation to interventions and should not usually be included as evidence.
(b)Other agencies
It is expected that a referral to a specialist behaviour support teacher would have already been made where the pupil’s behaviour, emotional and social difficulties are a very significant area of need.Please indicate:
Date of referral to Behaviour Support:The most recent reports are attached where available: Yes No
If not available please give the reason:N.B.
Please make sure that the name of the pupil, his/her date of birth and the date of the application are written on any additional information and accompanying evidence, then firmly attached to main the document. It goes without saying that a copy of everything should be retained and a note made of the date on which the request was sent to the SEN Area Office.
Section 4 – to be completed (where relevant) for pupils whose difficulties include physical/sensory needs(a)Evidence of physical/sensory needs and intervention
Where a pupil’s difficulties include physical and/or sensory difficulties the school will need to provide clear evidence of significant difficulties, how these impact on access to the curriculum and what special arrangements are made by the school.Please note that, as set out in the guidance for schools on statutory assessment, a medical diagnosis or label is not necessarily an indicator of special educational need.It is the impact on the pupil’s education that should be considered.
This information should be largely available within individual plans or personalised provision maps and reviews along with the evidence of curriculum differentiation and access arrangements attached to this request.
(b)Other agencies
It is expected that reports from other agencies will also be available where a pupil has significant physical and/or sensory needs.The school should demonstrate how it has incorporated this advice into individual plans to meet the pupil’s needs over a period of time.Please attach relevant recent reports from those outside professionals involved.
These might include: medical practitioners, consultants, paediatrician, physiotherapist, speech therapist, occupational therapist or specialist teachers.
(please indicate in Section 1 (e) which agencies are involved and whether a recent report
is attached)
N.B.
Please make sure that the name of the pupil, his/her date of birth and the date of the application are written on any additional information and accompanying evidence, then firmly attached to main the document. It goes without saying that a copy of everything should be retained and a note made of the date on which the request was sent to the SEN Area Office.
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