Request for Education, Health and Care Needs Assessment
- Details of Child/Young Person:
Full Name:Date of Birth:
Family Home Post Code:
- Person Making the Request for EHC Assessment
Young person (aged 16yrs +, or an advocate on their behalf)
Has a mental capacity assessment been completed for young person? YES/NO
If yes, please provide details of the person that carried out the assessment
and the date of the assessment.
Name of assessor: ......
Date of assessment: ......
Parent/ CarersSchool/EY Setting
HealthSocial Care
Post 16 ProviderTeam Around
(e.g. college, specialist college)The Child Mtng
Please provide full contact details of person making request:
......
......
- Actions already undertaken:
(Please tick box if paperwork is included with this request):
- One page profile
- Notes from Team Around the Child/ Family
- Analysis of assessment from outside agencies
- One page plan
- Multi-agency plan
- Review of multi-agency plan
Did a representative from the SEN Casework Team attend the Team Around the Child meeting? YES/NO
If yes, who attended? ......
- Details of Lead Professional
Full Name:......
Job Title:......
Email address: ......
Telephone Number:......
- Signature of Person Making Request
......
SignaturePrint Name
......
Date
- Personal Budgets
Please tick box if you are interested in receiving information regarding the option of Personal Budgets.
- Details of Where to Send Form
Once completed, please send this form to SEN Casework Team by the following routes:
Email:
Post: SEN Casework Team, 1st Floor, Block 1, Shire Hall, Westgate Street, Gloucester GL1 2TG
Confirmation of receipt will be automatically generated if request is sent by email. Postal requests will be responded to via email within 24 hours orby post within 2 working days.
Checklist for making a request for an Education, Health and Care Needs Assessment: (Please ensure you have enclosed all of the following)
- Views of parent
- Views of child/ young person
- Academic attainment and rate of progress
- Evidence where progress has been made only as a result of much additional effort and instruction at a sustained level over and above that which is usually provided (e.g. interventions used, date started, level of provision provided by the school).
- Nature, extent and cause (where known) of the SEN
- Evidence of the child’s physical, emotional and social development and health needs (e.g. up to date medical report – no older than 6 months).
- Where a young person is aged over 18 their age and evidence of whether remaining in education or training would help them to progress, building on what they have learned before and helping them to make a successful transition to adult life (e.g. progress to date, level of provision and how this has been used, evidence of how remaining in education or training will enable them to continue to make progress and how will it help them to make the transition to adult life).