SEN Support Plan Form
For use by Education Providers
Please complete this form using black ink or word-processing
Request for top up funding fora child with a SEN Support Plan
Name of Education provider: ……………………………………………………………………...
Name of Child / young person: ………………………………………. D/B: ……………………..
Address of Child / young person:.……………………………………………………………………...
…………………………………………………………………………………………………………………..
Name of Parents/Carers: ………………………………………………………………………......
Address if different to above: ……………………………………………………………………….
…………………………………………………………………………………………………………………..
1. / Information about the nature, extent and context of the child or young person’s SEN:Please also indicate primary need by ticking one box only on page 4 (for database purposes)
2. / Evidence of the child or young person’s academic attainment (or development milestones for younger children) and rate of progress
3 / Evidence of the action already taken to meet the child’s SEN - please attach school report - see checklist on page 3 for appropriate evidence.
4 / Evidence that where progress has been made, it has only been as the result of much additional intervention and support over and above that which is usually provided.
5 / Evidence of the child or young person’s physical, emotional and social development and health needs, drawing on relevant evidence from clinicians and other health professionals and what has been done to meet those needs by other agencies.
4 / External Specialists involved:-
ESS SALT Medical
BSS Physio/OT SSD
EPS CAMHS Other
Please specify
______
5. / Child or young person’s aspirations and views of strengths, weaknesses and special educational needs: (please indicate views and how they were obtained)
6. / Parent’s aspirations and views of child/young person’s strengths, weaknesses and special educational needs:-
Signed …………………………………………………. Head Teacher/SENCO
Evidence Required
(please tick to indicate evidence included)
· Views of parents· Views of child or young person
· A school / college report setting out
(i) the relevant and purposeful action already taken by school to meet and overcome the difficulties
(ii) evidence of rate and style of child’s progress over time
(iii) how the school has used it’s funding to meet the child’s needs
(iv) intended outcomes from any additional funding
· A copy of the SEN Support Plan
· reports from external specialists where involved
· evidence of extent to which advice from external specialists has
been followed and with what effect
· a Costed Provision Map and Support Timetable
· My Story
(Please make sure that all documentation is suitable for photocopying).
If not appended please give reasons
Primary Need
Please tick only
one box on this page
1. Communication and Interaction
(i) Autistic Spectrum Disorder
(ii) Speech and Language Delay
(iii) Speech and Language Disorder
2. Social, Emotional, and Mental Health
(i) Challenging, Disruptive or Disturbing Behaviours
(ii) Emotional Difficulty
(iii) Social Difficulty
(iv) Underlying mental health difficulties
3. Sensory and/or Physical
(i) Hearing Impairment
(ii) Visually Impairment
(iii) Physical Disability
4. Cognitive and Learning
(i) Specific Learning Difficulty
(a) Dyslexia
(b) Dyspraxia
(c) Dyscalculia
(ii) Moderate Learning Difficulty
(iii) Severe Learning Difficulty
(iv) Profound and Multiple Learning Difficulty
Please forward, preferably by e-mail to
4
Funding for SEN Support Plan Aug 2014