Department of Children’s Services

Request for Guidance from Equality & Access Officer

Name of Child: ………………………………… Date of Birth: …...…………. Male/Female

Name of Parent / Carer ………………………….Tel No: ……………………………………...

Address……………………………………………………………………………………………..

…………………………………………………… Post Code: …………….……………………

Sessions the Child Attends:…………………………………………………………………

Date the Child started:………………………………………………………………………………

Setting’s name:………………………………………………………………………………………

Setting’s Address:……………………………………………………………Postcode:…………..

Setting’s Phone No:………………………………………………………………………………….

Setting SENCO or Manager or Leader:…………………………………………………………

Name of Child’s Key Person: ………………………………………………………………………

Names and contact details of all professionals involved: ……………………………………….

…………………………………………………………………………………………….…………...

……………………………………………………………………………………….………………...…………………………………………………………………………………………………………

Does the family have a CAF/TAC? Yes/No if yes please give date:…………………………..

If yes, what is the name of the Lead Professional:……………………………………………….

What would the setting like support with?......

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

The parent/carer has received information explaining the role of the Equality and Access Officer Yes No

Parent/Carers comments: …………………………………………………………………………………………………..……. …………………………………………………………………………………….……………...……

……………………………………………………………………………………………………………………………………………………………………………………………………………………

Parent/Carers consent:

I agree to the information the setting and I have provided being passed on to Children’s Services and entered on to a shared database system. I agree to information being shared between relevant partner professionals in children’s centres, schools, health services, social care, education and voluntary organisations, to support a partnership approach to meeting my child’s needs and in the best interests of the child. The agencies listed above, may contact me and send me information on services and events. Information may be used for monitoring purposes.

Please ask the child’s parent/carer to complete the following ethnic origin for the child which is a requirement of Bradford Council.

Any other Asian background / Any other ethnic group
Bangladeshi / Cornish
Indian / White Eastern European
Mirpuri Pakistani / English
Other Pakistani / White Western European
Pakistani / Greek Cypriot
Sri Lankan Other / Greek
Black Caribbean / Any other White background
African / British
Any other Black background / Irish
Chinese / Traveller - Irish Heritage
White/Black African / Other white British
Any other Mixed background / Roma/Roma Gypsy
White/Asian / Scottish
White/Black Caribbean / Turkish Cypriot
Welsh / Turkish

Jo Sunley

Equality and Access Officer – Bradford South

SEN Early Intervention Team

SEN Services

2nd Floor

Margaret McMillan Towers

Princes Way

Bradford

BD1 1NN

Tel: 01274 431280 / Mobile 07582 102644