Parental contribution to Educational Health and Care

(EHC) needs assessment

Child’s personal details
Legal surname
(Also known as, if appropriate) / Other names
Date of birth / Age / NHS No.
Gender / Female / Male / Ethnicity / Forces family / Yes / No
Home address
Postcode
Current educational setting
Person/s with legal parental responsibility details
Title / Initial / Surname
Address if different from child or young person
Postcode
Email
Telephone / Mobile
Title / Initial / Surname
Address if different from child or young person
Postcode
Email
Telephone / Mobile

We would like to hear from you about your child. This is important information which will help the local authority decide whether your child would benefit from an EHC plan.

Please refer to the Parental contribution to an Education, Health and Care needs assessment guidance for further information on how to complete this form.

There are many important people in a child or young person’s life, however, this form needs to be completed by the person/s with legal parental responsibility.

About your child

This section is for you to tell us about your child.

Your child’s journey so far

What is your child like now?

How does your child need to be supported to be heard and understood?
What are your child’s strengths and what do they find more challenging?
What does your child like and dislike?

Please tell us what you feel is working and what is not working for your child in terms of their:

Friendships and relationships
What’s working
What’s not working as well as you’d like
Health and well being
What’s working
What’s not working as well as you’d like
Learning, achievement and educational progress
What’s working
What’s not working as well as you’d like
What are your aspirations for your child?
How do you think an EHC plan might help your child?
What are the key points to be included in an EHC plan if one is written?
(Your full contribution would be included as one of the appendices to the EHC plan. In the EHC plan itself your contribution would be summarised. Your key points will be helpful for this.)
Name of person with legal parental responsibility completing this form
Signature
Relationship to child
Date completed
Name of person with legal parental responsibility completing this form
Signature
Relationship to child
Date completed

Please return the completed form to the SEN Assessment and Provision Team at 3W, County Hall, Truro TR13AY or to your child’s educational setting

Or alternatively you may use email to send an electronic copy of the form to

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