Principles
  • All children in Rutland are entitled to be educated within their local community where possible
  • All children with SEND should have a broad and balanced curriculum
  • Early Years Settings, Schools and Post 16 providers are able to adapt their structures and systems to include all pupils using reasonable adjustments
  • Early Years Settings, Schools and Post 16 providers can be empowered to find solutions to problems through the support of the SEND team

Please Note for Academies and Independents Only:
As from April 2013 all non statutory services will be chargeable as follows:
Training & Consultancy - Per hour: £70.00
Per half day: £200.00
Per day: £350.00
Complete all areasOffice use only:-Scanned Checked on RAISE
Child’s Name: / DoB: / NCY:
M/F: / Ethnicity: / 1st Language:
Home Address:
Parent/Carer Name:
Parent/Carer Telephone No:
EYFS Setting/School/Post 16:
Sessions attended (if in EY’s Setting):
Date of Entry:
SEN COP EHC / Statement
LAC Child Yes No Known to Social Care Yes No CAF Yes No
EYFS/Pupil premiumYesNo
Person requesting involvement:
Address:
Role: / Telephone No:
Child/Young Person’s strengths and successes:
Child/Young Person’s views
Parent/Carer aspirations and view of how referral might help:
Nature/Area of Concern, describe how it impacts on learning:
  1. Communication and interaction
  1. Cognition and learning
  1. Social, emotional and mental health difficulties
  1. Sensory and/or physical needs

Provide “evidence of action already taken by the school?” (Please indicate if relevant reports, observations, reviewed Support Plans)
What outcome would you like from this referral?
Other Agency Involvement:
Speech Therapy / Occupational Therapy / Physiotherapy
Health Visitor / Paediatrician
Team Around the Family / CAMHS
Social Care / Child In Care: / Yes / No
Specialist Teacher: / Hearing Impaired / Visually Impaired
Youth Offending Team / Other
I give my consent for
a) information contained within this request for SEND / Inclusion Team involvement to be shared with other agencies providing support services to children, young people, their families and carers
b) direct professional involvement / work
Parent/Carer:
Young Person (where appropriate):
Date:
Person requesting involvement:
Signature: / Date:
Countersign Headteacher/Manager:
Signature: / Date
Please attach copies of the following documentation where appropriate:
Last reviewed Support Plan:
Current Support Plan:
Most recent review meeting notes:
Levels of attainment/tracking documents:
Assessment reports:

This form, with attachments, should be forwarded to:

Mrs Sandra Craker, Education Services, Rutland County Council, Catmose, Oakham, Rutland - LE15 6HP - Tel: 01572 758496

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