Setting/School / Date application completed
Contact details of child / Primary Need
Communication and Interaction / Cognition and Learning
Social Emotional Mental
Health Difficulties / Sensory and Physical Needs
Person with parental responsibility giving informed consent to the application
Tel
Name ………………………………(Relationship) ………………..……..Signature ………………………………………………..….…………..
LAC (Y/N) (please include PEP) / CAF (Y/N) CP (Y/N)
CIN (Y/N)
APPLICATION FOR HIGH NEEDS FUNDING
Settings/schools must have evidence that the recommended provision for children in different SEN categories has been made or attempted prior to the application for the High Needs Block funding. This evidence is explained in the following sections ‘Assess, Plan, Do, Review’
Current Band / Band RequestedApplications for Band C funding and above must include corroborating evidence from an independent SEN expert e.g. Educational Psychologist or Speech and Language Therapist.
Application authorisation and completion signaturesIn signing this application you are acknowledging that all essential information is present
Head Teacher / Date
SENCO / Date
ALL OF THE FOLLOWING INFORMATION MUST BE SUBMITTED
TO SUPPORT THIS REQUEST
(Please use the following checklist as the minimum information required for submission to panel. If applications are received without the following they will be returned to the applicant without being considered by panel)
ASSESSCopy of relevant reports from agencies involved with the child.
One must be in the last12months (essential for application for Band C and above)
Professional Involved / Agency / Date of report
Office Use. Initial ______
PLAN
Primary - Copy of child’s SPRINT tracker –(or similar) for at least 2 terms
Secondary - Copy of all subject assessment data for at least 2 terms
Primary Need provision printout from School Support offer
(This should detail what school offers for the difficulties the child may be experiencing. Please tick each provision the child is/has been receiving – this will cross reference with your costed provision map. You should also clearly annotate the provision that High Needs funding would provide by marking with ‘HNF’)
Copy of costed provision map (please use the Stockton format to complete this – all sections MUST be completed). Evidence of support provided from element 2 (additional support funding up to 6K) funding presented to High Needs Block Panel must be in excess of this.
Copy of individual timetable
Office Use. Initial ______
DO
What additionality will you provide for the child with the funding?
(this should cross reference with your printout from your School Support Offer – see ‘PLAN’ section of this application)
Desired Outcome / Provision required / Success criteriaOffice Use. Initial ______
REVIEW
Progress (over time) of provision school has provided to meet the child’s needs.
(This must be in the format of the review tab in the costed provision map)
Office Use. Initial ______
A report from school detailing the current situation ( NC levels/assessments covering
24 months). You should provide a ‘pen picture’ of the child which includes:
- thechild’s main strengths and weaknesses.
- actions which have been taken to address the child’s difficulties which are not outlined in the above information.
- details of engagement with parents and their thoughts regarding the future provision for their child.
- details child’s views regarding their future support and provision.
- information relating to the child’s home circumstances and any Social Servicesinvolvement (if relevant).
- reference any provision from Stockton Borough Council’s Local Offer
Where funding is granted from the High Needs block it will be outcome related and time limited and subject to regular review, the regularity dependent on the individual’s circumstances but at least annually.
Office use
Date / Office SigApplication complete
Scheduled panel date
Outcome
Funding Agreed Y/N
Funding Period agreed
……………….. months/term(s)
Band …………
Outcome communicated with school
Outcome communicated with parent/carer