BUCKINGHAMSHIRE COUNTY COUNCIL

ANNUAL REVIEW - REQUEST FOR CHANGE TO SPECIALIST PLACEMENT

Schools/settings must be able to demonstrate they have taken appropriate actionto support the child within the current setting before making a request for a change to specialist placement.

Failure to complete this form as fully as possible, including full details of how the child/young person has been supported and what professional advice has been sought and implementedto date, may result in a request being turned down because of a lack of evidence at the panel meeting. If you are unable to do this because of a sudden change in the child/young person’s circumstances (e.g. traumatic injury), please make this clear in your submission.

1. ESSENTIAL DOCUMENTS TO BE SENT WITH THIS COMPLETED FORM TO:
S.E.N. Team
County Hall
Aylesbury
HP20 1UZ
Headteacher’s Report of the Annual Review Meeting / Educational Psychologist and/or Specialist Teacher advice / report
Other Professional advice / reports / Reviewed IEPs/ Provision Maps
Attendance Certificate (schools only)
2. CHILD/YOUNG PERSON – Please give first names in full, as registered
Surname / First name(s) (in full)
DOB / NCY / Primary SEN / Additional SENs
Name of current school/setting
Brief summary of the support required in the current school/setting:
3A. MAINSTREAM SCHOOLS & ACADEMIES - What is the school’s current SEN Budget (please include Prior Attainment, Deprivation (IDACI) and Top up funding as identified on your School’s Budget breakdown)? / 3B. SPECIAL SCHOOLS & ACADEMIES – Please provide the child’s current Locator and indicate if this has been moderated
£ / Locator
4. What professional advice has been sought and how has it been used to support this child’s needs over at least six months? (Please enclose supporting documents e.g. reports, consultation records, I.E.P.s & reviews).
Date this advice was given? / Who gave this advice & contact details? / What was the advice/agreed actions? / Implementation – what was done, how often did it take place and when did it start? / Date reviewed. What was the outcome for the child/young person?
5. PROVISIONOVER PAST 12 MONTHS & IMPACT
Description of provision e.g. equipment, training, staffing etc. / Impact of provision e.g. progress on a specific test or using EYFS/P/NC levels, reduction in behaviour incidents? / 12 Months Cost £
TOTAL
5. What outcome(s) might a specialist placement be able to achieve that the current placement (or, for children transferring to school from pre-school settings, mainstream school) cannot and how?

This request will be considered by the Specialist Placement Panel. If agreed, consultation will take place with appropriate specialist placements to ensure (as far as possible) that the placement will be successful. This process takes several weeks, it is important that schools staff and parents are aware of this.

Head Teacher/Setting Manager’s Signature: ______

Name (Printed): ______

Date: ______

- 1–

July 2013