July 2014

Health / Other

Educational Advice 1

Education Act 1996

Child’s Name: / NHS Number: / Male/Female / DOB:
Is the child a ‘looked after child’ Yes/No
If yes, who has parental responsibility?
Home Telephone No. / Mobile:
Preferred language at home: / Other languages:
Interpreter required? Yes/No
Parents Name and Family Contact Address:
Are you aware of any active safeguarding concerns in connection with this child? Yes/No
Are you aware if this child has a CAF? Yes/No
Please provide information about the child’s early education provision:
Child is currently not accessing any Early Years provision and is at home: Yes/No
Child is due to attend on the
Child is currently accessing (please provide the name of the setting/named contact and telephone number)
·  Children’s Centre
·  Childminder
·  Day nursery
·  Playgroup
·  Nursery School
·  Primary School Nursery Class
Details of the person completing the form:
Name in capitals:
Job title:
Work base:
Signed and dated ……………………………………………………

Please provide relevant details regarding the child’s development in relation to:

Medical
Personal, Social and Emotional Development
Communication and Language
Physical
Other

Professionals currently involved (Please specify any key worker)

Name / Professional role / Contact details

Information has been shared with the family about the following services:

Early Support / Yes/No
Portage / Yes/No
Disabled Children’s Register/Newsletter / Yes/No
Family Information Service / Yes/No

Please send completed form to: SEN Team, Department of Children & Young Peoples Services, Margaret McMillan Tower, 1 Princes Way, Bradford BD1 1NN

Educational Advice 1 (EA1)

Parental Consent Form

This notification has been discussed with the parents/carers of ………………………………….

who know that this may result in contact from your child’s Early Years setting or an Education Support Service or Child Health Services.

I agree to the information contained in the Educational Advice 1 being forwarded to the relevant setting support service and understand that I may be contacted to discuss my child’s needs.

Parents Signature: …………………………………………………………………………………….

Date: ……………………......

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