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Request for Area SENDCo Visit

To be completed at Targeted Level 2. Please complete all areas of this form.

Child’s Name: / Date of birth:
Child’s Address: / Parent/Carer’s Name:
Home & mobile No:
Email:
Name of setting:
Date child started:
Sessions attending: (Days & times please) / Name of Key person:
Name of SENDCo:
Does the child access the 2 year offer or 2 year plus?(please tick the relevant
box) 2 year offer  2 year plus
Does the child attend any other Early Years Setting? Yes / No (If yes please give name of setting and sessions attending?)
Area of SEN (Support)
Communication and Interaction 
Cognition and Learning 
Social, Mental and Emotional health 
Sensory and/or Physical 
Have you completed the following?
SEN Support register:
IEP completed:
IEP reviewed:
Strategies and advice accessed and implemented: / What is the outcome?
Medical Condition:
Please attach an IEP and a reviewed IEP
Form Completed by:
Name:(Please print) / Role:
Signature: / Date:
Other Professionals or Agencies:
Please give names of any other professionals or agencies that have been working with the child and family, including those you have referred too. (Please include GP name and address)
Specialist / Name / Tel No / Report
attached / Already Involved/ have you been referred
(if referred include date)
Transition (please complete if known)
Name of Nursery/Infant school the child is likely to enter: / Expected date of entry:
Parent’s comments
Parental Consent
I confirm that I give my consent for the pre-school/nursery to seek advice and support for my child from the Area SENDCo Team. The pre-school/nursery has explained the reason for this and the arrangements that will be made.
Please note that the Area SENDCo Team is part of the Children & Adults with Disabilities Service which is an integrated service working with Health and Social Work Teams with whom information may be shared in the best interest of the child.
Parent/Carer Signature:
Date:

Please return completed form with copy of IEP to:

Area SENDCo Team,

Children and Adults with Disabilities 0-5 Support Team

Town Hall, Main Road, Romford, RM1 3BB

t 01708 434080

Email:

______

For Office use only:

  • Telephone Contact
  • Visit
  • Consultation
  • Child known Yes / No Known to:

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Systems Files – Area SENCo – Area SENCo Referrals – Request for Area SENDCo Visit – 01-2017