Add Name of child here (Appendix G- Health)
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 numberName 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 againplease 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;
NameJob 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 / Writing0-11m / See
DevelopmentMatters
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 measure0-11m
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 / Technology0-11m
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 imaginative0-11m
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-control0-11m
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-care0-11m
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 / Speaking0-11m
8m – 20m
8m -1y8m
16m – 26m
1y4m -2y2m
22m – 36m
1y10m -3y
30m – 50m
2y6m-4y2m
40m – 60m
3y6m-5y+
Pupil Profile Information Appendix G Health
Complete as appropriate by circling or highlighting the statement.
HEALTH NEEDSUniversal Needs / Additional Needs / Complex Needs / Severe Needs
EPILEPSY
Infrequent seizures occurring on average less than once per month. / Seizures that occur on average more than once per month. / Seizures that occur on average more than once per week. / Seizures that occur on average more than once a day.
Seizures that are easily recognised. / Seizures that can be recognised by staff having received generic epilepsy training. / Seizures that can be recognised by staff having received child specific training. / Seizures present in many different ways and are difficult to recognise, staff require ongoing child specific training and support.
Seizures that do not usually require rescue medication. / Seizures that have required rescue medication. / Rescue medication required on average monthly. / Rescue medication required on average weekly.
Seizures that do not usually have an impact on the CYP's airway. / Seizures that have a minor impact on the CYP's airway requiring first aid treatment (staff trained in first aid). / Seizures that have a major impact on the CYP's airway requiring emergency services (staff trained in first aid). / Seizures that affect the CYP's breathing to the extent that they require oxygen and or suction to maintain airway (staff trained in basic life support).
Seizures do not generally require immediate intervention. / CYP requires a low to moderate level of observation to manage seizures safely. / CYP requires a high level of observation to manage seizures safely. / CYP requires constant observation due to seizures that require immediate intervention such as positioning to maintain airway.
AIRWAY MANAGEMENT TYPE A
No identified risk of airway difficulties. / CYP requires medication to reduce secretions (hyoscine patches or oral medication). / CYP requires repositioning to be able to manage secretions effectively. / Pooling of secretions at the back of the throat and difficulty in swallowing requiring constant supervision and oral/naso pharyngeal suction.
Normal lung function. / N/A / N/A / Chronic lung disease causing reduction in respiratory function and high risk of developing chest infections
No requirements for chest physiotherapy. / CYP may require chest physiotherapy at home if need identified by health professionals. / Requires regular chest physiotherapy at home. / Requires regular and as required chest physiotherapy in school to maximise respiratory function.
Pupil Profile Information Appendix G cont….
Complete as appropriate by circling or highlighting the statement.
HEALTH NEEDSUniversal Needs / Additional Needs / Complex Needs / Severe Needs
No requirements for oxygen therapy or availability of oxygen. / N/A / Requires oxygen when unwell at home/hospital. / Requires oxygen therapy or availability of oxygen at all times.
AIRWAY MANAGEMENT TYPE B
No tracheostomy. / N/A / N/A / CYP has a tracheostomy to maintain airway. Requires constant supervision to provide suction or potential emergency management at any time.
AIRWAY MANAGEMENT TYPE C
CYP has normal breathing. / N/A / CYP requires mechanical ventilation at night time only or when unwell at home. / CYP cannot breathe unaided for part or all of the 24 hour period and is reliant upon assisted mechanical ventilation. Requires trained supervision to assess whether mechanical ventilation required at any time.
SUSTAINED DEBILITATING OR UNPREDICTABLE MEDICAL CONDITION
May have a medical condition but does not require monitoring or extra support. / N/A / CYP has medical condition that requires monitoring and support from school staff trained by health professional. / Has a medical condition that involves dependence on a trained adult for most or all of the day to monitor and provide medical interventions when necessary.
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 G HNF 2018 V3