Request for Involvement of SEN Support Services

Education and Early Years

Children, Schools and Families

Request for Involvement of SEN Support Services

Please complete the Request for Involvement form and then email the form securely to the appropriate service as listed at end of the document.

Please note any referral submitted without a parent/carer consent form will not be processed. Please ensure you have a copy of ‘How Children, Schools and Families use your information to provide services’ available on request to show parents/carers. This brochure can be downloaded from the SEN File, Forms and Guidance page in the requests for involvement section.

Child Information
Full Name of Child: / DOB:
Male/Female: / N.C.Year Group: / School attendance record%: / Unique pupil number (UPN)
Home Language: / Ethnicity:
Date placed at SEN Support / Date when allocated a EHCP
(if appropriate )
Names of Parents/Carers:
(if child is in care please also state who has parental responsibility) / Contact Details:
Home Tel:
Mobile:
Email:
Pupil’s Address:
Post Code:
Child in Care?
Yes ☐ No ☐ / Additional Adults with Parental Responsibility:
Name:
Address:
Child in Need?
Yes ☐ No ☐
Child/Family CAF/TAC or Early Support? Yes ☐ No ☐ / Date started: / Lead professional:
School Information
Current School/Setting: / Date of Entry:
Name of person making this request for involvement of SEN support Services;
Role title :
Address :
phone number:
contact e mail address:
contact email address for SEN Support Services to send future correspondence regarding completed visits to the setting (if different from the above):
SEN Support Services Involvement
Please indicate who you are requesting involvement from
Details of eligibility criteria are listed at the end of this document
☐Augmentative and Alternative Communication Team
☐Cognition and Learning Service
☐Hearing Support Team
☐Physical and Medical Needs Advisory Service
☐Vision Support Team
Current levels of attainment as measured in school:
Please give an indication of where the child/young person is currently working according to your assessment systems. Please attach relevant school reports.
Please list other agencies involved and dates of involvement in the last 12 months (e.g. Educational Psychology Service, Social Care, Speech and Language Service)
Name of Agency / Name of Professional / Contact Details

Current identified areas of Special Educational Need

(please indicate the identified areas of need)

Cognition & Learning / Sensory and/or Physical Needs
Specific Learning Difficulty / Hearing Impairment
Moderate Learning Difficulty / Visual Impairment
Severe Learning Difficulty / Multi-sensory Impairment
Profound Learning Difficulty / Physical Disability
Emotional, Social & Mental Health / Communication & Interaction
Emotional, Social & Mental Health / Speech and Language Needs
Social Communication Needs
Reason for referral (if referring to a known diagnosis, please give date diagnosis was made and by whom )
Have there been any significant changes in the child/young person’s context at school or home?
Current school intervention(s):
Please attach the student’s current Individual Provision Map/equivalent or evidence of “Assess, Plan, Do Review”. You may also refer to the ‘Graduated Response in Mainstream Schools’ document to provide this information.
Educational Outcomes expected by the school from the involvement of the SEN Service - for example any particular curriculum access needs?
The pupil will:
What educational outcomes does the child/young person want to achieve?
for example any particular curriculum access needs?
I will ……………
What educational outcomes do the parents/carers want their son/daughter to achieve? For example any particular curriculum access needs?
(name of child young person ) will …………….

Please ensure all sections of the form are completed and relevant information included (See checklist below for essential information to be included).

Please note any referral submitted without a parent/carer consent form will not be processed. Please ensure you have a copy of ‘How Children, Schools and Families use your information to provide services’ available on request to show parents/carers. This brochure can be downloaded from the SEN File, Forms and Guidance page in the requests for involvement section.

Information required / Copies attached
All sections of referral form are completed / Yes/No
Signed Parental consent form / Yes/No
Evidence of Assess, Plan, Do Review cycles / Yes/No
Please send the completed Request for Involvement form and signed consent form electronically via secure email to the appropriate service:
Augmentative and Alternative Communication Team:
Cognition and Learning Service:
Hearing Support Team:
Physical and Medical Needs Advisory Service:
Vision Support Team:
Data Protection Act – Privacy Notice
We, Children, Schools and Families Directorate, Cornwall Council, New County Hall, Truro, TR1 3AY, Data Protection Registration Number: Z1745294 are committed to protecting and respecting your privacy.
This information is being collected by SEN Support Services, on behalf of Cornwall Council as Data Controller for the purpose of determining the educational needs of the named pupil. The SEN Services are :
Augmentative and Alternative Communication Team:
Cognition and Learning Service:
Hearing Support Team:
Physical and Medical Needs Advisory Service:
Vision Support Team:
Data on you or your child may also be shared with other relevant professionals who are SEN Support Services, Educational Psychologists, Statutory SEN Service staff, teachers, relevant health staff (Speech and Language Therapist, Physiotherapist, Occupational Therapist, Audiologist, Orthoptist and social workers, to inform their work. The data held relating to the delivery of support by the relevant Support Service(listed above) to your child will be used both for the provision of services and also for performance and service planning. This information will be held in a secure environment until the individual’s 30th birthday in accordance with the CSF data retention policy after which time it will be destroyed in a secure manner.
A copy of our Privacy Notice can be found at www.cornwall.gov.uk/csfprivacynotice. This Privacy Notice sets out the basis by which any personal data we collect from you, or that you provide to us, will be processed by us, in accordance with the General Data Protection Regulations (GDPR) and the Data Protection Act.
For further information or assistance on Data Protection matters, please contact the Practice Development and Standards Service on 01872 327617 or e-mail
Or the Councils Data Protection Officer
You have the right to withdraw consent to the processing of your data at any time and your further rights as to how we handle your data can be found by following the above link. Should you wish to withdraw your consent please contact the relevant team - see contact details listed above.

Eligibility Criteria for Involvement of SEN Support Services

Augmentative And Alternative Communication

Eligible pupils will:

• either have been assessed/or being assessed through the Cornwall AAC assessment pathway (CAACAT). This is a joint assessment process, involving Speech and Language Therapists and staff from the AAC team

• be using a powered (or hi tech) communication aid provided by Cornwall Local Authority or one provided by NHS England

• use this communication aid as a main mode of communication

Cognition and Learning

Eligible pupils will:

• have Cognition and Learning needs including either moderate learning needs (MLD) and specific learning needs (SPLD)

• be achieving significantly below age related expectations

• attend a mainstream educational setting

The school or educational setting must:

• evidence 2 cycles of Assess, Plan, Do Review (involving pupils and parents/carers)

• evidence that they have implemented a period of intervention with a focus on desired outcomes (over a period of at least a term/12 weeks)

Hearing Support

Eligible pupils will:

• have a diagnosed hearing loss (Schools can request an initial hearing assessment, by completing the CHA1S referral form and return it to Treliske Hospital)

The school or educational setting must:

• evidence how a pupil’s hearing loss is impacting on the pupil’s education, social interaction or their well-being in the setting

The Hearing Support Team will request that medical information related to the child / young person’s hearing loss is shared with the Team prior to their involvement. This facilitates consistency of medical and education advice.

A standardised set of criteria will be used to determine levels of support using the National Sensory Impairment Partnership guidelines

Physical and Medical Needs

Eligible pupils will:

• be attending a mainstream educational setting or an Area Resource Base

• have a physical and/or medical need which affects their ability to access the curriculum, for example within the classroom environment, in practical lessons or school trip

Referrals are accepted from schools (usually the SENCO), from medical professionals and from other colleagues in the Council's Support Services.

The Physical and Medical Needs Advisory Service can provide Moving and Handling Training for staff working with specific students. ‘In Safe Hands’ is the new provider of Moving and Handling training for mainstream and Area Resource Base staff. Please contact the Service using the email: for the referral form for Moving and Handling.

Vision Support

Eligible pupils will:

• have a diagnosed visual impairment , diagnosed by an Ophthalmologist

• have a visual impairment which impacts on their ability to access the curriculum and any aspect of their learning

The school or educational setting must:

• evidence how a pupil’s visual impairment is impacting on the pupil’s education, social interaction or their emotional well-being in the setting

The Vision Support Team will request that medical information related to the child/young person’s visual impairment is shared with the Team prior to their involvement. This facilitates consistency of medical and education advice. A standardised set of criteria will be used to determine levels of support using the National Sensory Impairment Partnership guidelines.

If you would like this information to be provided in an alternative format please contact the appropriate SEN Support Service