Annual Review Report Form

Annual Review Report Form

for a child subject to

a Statement of Special Educational Needs / Education, Health and Care Plan (EHC Plan) / Moving On Plan

Date of Statement / EHC Plan / Moving on Plan or last annual review
Date of current review meeting
Primary area of need (as per Statement / EHC Plan / Moving On Plan)

Section 1: Background Information

1a. My details
Surname / Forename(s)
Date of Birth / Year Group
Home address
Names of parent(s)/carer(s)/person responsible
Address of parent(s)/carer(s) if different to above
Is the child/young person subject to a Care Order (where the Local Authority shares parental responsibility?) / Yes / No
Is the child/young person accommodated under Section 20 of the Children Act 1989? / Yes / No
Are these details different from those on the Statement / EHC Plan / Moving On Plan? / Yes / No
1b. My school
Name of current placement
Date of admission
Attendance to date / Actual / Possible / Percentage
Is the child dual registered? / Yes / No / If yes, where?
Has a CAF been completed? / Yes / No Please attach a copy if within the last 12 months
Lead Professional
1c. Who is important to me?
List all those invited to, and indicate if present at, the annual review meeting
Name / Details (including job
title, telephone number and e-mail) / Indicate if
present at meeting / Written contribution provided?
Prior to the meeting / At the meeting
1d. Plan Co-ordinator
The Plan Co-ordinator / Lead Professional responsible for reviewing this plan
Contact details (including address, telephone number and e-mail)
How will pupil name be involved in this review?
1e. My health
Any diagnosed medical condition / Diagnosed by / Date of diagnosis
1f. Documentation provided in support of the annual review
List all reports gathered since Statutory Assessment / the last annual review, used in support of this
review process. All reports referenced should be provided within the final annual review submission. Any reports submitted may be used for the purpose of converting a Statement / Moving On Plan into an EHC Plan.
Report name / Date of report / Provided by
Name / Role
1g. Has an updated "This is Me Now" form been completed?
An updated "This is Me Now" form should be completed for each review, and attached to this form
Completed by
Relationship to child / young person
Date completed

Section 2: Update on Pupil Name's Strengths and Skills

2a. What do people like and admire about me?

2b. What do I need to stay safe and healthy?

2c. What is important to me now?

2d. What do I find difficult?

2e. What is currently working well in my placement? What am I proud of?

2f. What is currently working well outside of my placement?

2g. What is currently not working well in my placement?

2h. What is currently not working well outside of my placement?

2i. What is important to me in the future?

2j. What will be important for me in the future?

Section 3: Progress Made and Support Provided

3a. What is working well?
Provide views of those present on progress achieved towards the stated outcomes in the Education,
Health and Care Plan as well as the Action Plan from the previous year. This should include evidence to show how support provided is helping to achieve those outcomes.
Outcome
Progress made / Pupil views
Parental views
School views
Other professional views
Support provided / Support / By whom / Where / £
Outcome
Progress made / Pupil views
Parental views
School views
Other professional views
Support provided / Support / By whom / Where / £
Outcome
Progress made / Pupil views
Parental views
School views
Other professional views
Support provided / Support / By whom / Where / £
Outcome
Progress made / Pupil views
Parental views
School views
Other professional views
Support provided / Support / By whom / Where / £
3b. Additional factors influencing my progress
Additional information on factors influencing progress. This should be included in the future Action
Plan, for the following year, where appropriate. This should take account of the Education, Health and Care factors affecting the child / young person.
School
Out of School
Support provided outside of school / Support / By whom / Where / £
3c. My Action Plan
Outcome / Action / By whom? / By when? / How will I know it has worked?
4a. Profile of Need / Specific Learning Difficulties
Dispositions and Attitudes
Social Development
Cognitive Ability
Emotional Development
Speech and Language
Vision
Hearing
Physical Health / Medical

4b. Attainment and progress

Please provide details of National Curriculum levels, demonstrating both current attainment and rates of progress. Please use P scales where appropriate.

EYFS
Areas of Learning / Personal, Social and
Emotional Development / Communication and Language / Literacy / Mathematics / Understanding the World / Physical Development / Expressive
Arts and Design
Self-confidence and self-awareness / Managing feelings and behaviour / Making relationships / Listening and attention / Understanding / Speaking / Reading / Writing / Numbers / Shape, space and measure / People and communities / The world / Technology / Moving and handling / Health and self-care / Exploring and using media and materials / Being imaginative
Score
NC Year / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11
TA / SATS / TA / SATS
Reading
Writing
Science
Maths

Section 5: Outcome and Support for the Coming Year

5a. Agreed outcomes for the coming year
Are there any
changes to existing outcomes required? / Yes / No If yes, please indicate required changes below
Existing outcome / What is to be
changed?
Support required / Support / By whom / £
Existing outcome / What is to be
changed?
Support required / Support / By whom / £
Additional outcome
Support required / Support / By whom / £
Additional outcome
Support required / Support / By whom / £
5b. Travel Assistance
Does pupil name receive travel assistance? / Yes / No
Is this an exception to the home to school transport policy? / Yes / No
Have there been any changes to
pupil name's circumstances since travel assistance was last reviewed? / Yes / No / Not Applicable
If yes, please provide details and any supporting evidence
Is travel assistance provided as part of a personal budget? / Yes / No
If travel assistance is not provided,
have circumstances changed so significantly that this now needs to be reconsidered? / Yes / No / Not Applicable
If yes, please provide details and any supporting evidence
5c. Personal Budget
Does pupil name receive a personal
budget? / Yes / No
Are any changes to the personal budget recommended? / Yes / No / Not Applicable
If yes, please provide details and
any supporting evidence
5d. Placement
Does the current placement remain appropriate? / Yes / No / Is the pupil ready to
be included in a mainstream environment? / Yes / No
If special school placement, does the banding remain appropriate? / Yes / No / If no, recommended new banding
If the pupil is in Year 1, please indicate parental preference for junior school
If the pupil is in Year 5,
please indicate parental preference for secondary school
If the pupil is in Year 10 or
above, please indicate their preference for future placement
5e. Summary
Comments
Does the Statement / EHC Plan remain appropriate? / Yes / No
Is it recommended that the Statement / EHC Plan is
amended? / Yes / No
Is a re-assessment recommended? / Yes / No
Is any further action required? / Yes / No

5f. Any differing recommendations or additional comments

5g. Signatures
Young person / Date
Parent / Carer / Date
Plan Co-ordinator / Date
Head Teacher / Date

Please return this form, together with any supporting records / information, to the SEND Team, Derby City Council, Children & Young People, Business Hub, The Council House, Corporation Street, Derby DE1 2FS