In support of your application, please ensure that you have included:

Completed funding request which is signed by all parents.

Support provision:

Provision map - class, year group, key stage, whole school (two of the most appropriate dependent on size of school)

Assess, plan, do and reviewed documents demonstrating that targeted/personalised support has been provided over at least two terms

Evidence of assessments/interventions – including a completed FACT or FACT+, pre and post intervention data

Evidence of training – ASD - AET level 2, Cognition and learning – dyslexia or dyscalculia, SEMH – children that challenge us or Attachment

Detailed timetable showing evidence of the targeted/personalised support that has been provided for the group of children

Reports from professionals

Financial:

Detailed costings and breakdowns of the delegated resource for each child or young person within the request and an overview of how the SEN (notional) budget is used within the whole school

Progress data:

Individual child or young person’s attainment data over 1 year, including evidence that school has monitored and evaluated where progress is below expected and the gap has not narrowed

School Name: / Post Code:
School phone number: / email address:
School Contact Name: / SENCO:
Number of children/young people / In total / High Needs
Whole setting
Number in the child’s session:

Please complete for each child who requires high needs funding and the outcomes you are hoping to achieve for each individual.

Child’s name: / Date of Birth: / Gender: / Setting group:
In order, please number which categories of need are relevant to the child/young person:
Cognition and Learning / Communication and Interaction
Social, Emotional and Mental Health / Sensory and / or Physical
FACT or FACT completed: Please circle as appropriate
Yes – please include / No – please explain why?
Summary of need:
Outcomes: / Proposed strategies:
1. / 1.
2. / 2.
3 / 3.

N.B Please copy as required for the number of children.

Reason for request:
Detail of any internal specialists / external professionals involved including duty calls:
Details of training received within the school in the last two years:
Course: / Company: / Attendees
Number of hours being requested / Number of weeks / Has funding been given before? If so provide the date

Signed ______(Child 1’s parent)

Parent/Carer and/or young person (if over 16) please ensure there is an electronic signature attached.

Date: ______

Signed: ______SENCO/Inclusion Manager

Date: ______

Signed ______(Child 2’s parent )

Parent/Carer and/or young person (if over 16) please ensure there is an electronic signature attached.

Iagree with this request for support and understand that these requests will be discussed at the SEND Inclusion Forum. (The Forum is made up of representatives from Local Authority, Schools/Settings, Health and Social Care).

Signed: ______SENCO/Inclusion Manager/Tutor

Please ensure there is an electronic signature attached.

Date:______

Signed: ______Headteacher

Please ensure there is an electronic signature attached.

The request cannot be presented to panel without all signatures, please complete one form for each child within the group request.

To ensure that allocated High Needs Funding is being used as outlined in the application, the Inclusion and Intervention Team will contact you to review and a monitoring visit may be arranged and where necessary, further advice and support may be given.

1 SchoolGroup Top-Up Funding Request – October 2017