School/College Application for Statutory Assessment of SEN

Note:

  • The criteria relates to a significant learning difficulty or a disability that calls for special educational provision
  • Most documents should be ones that the school/college already have on record
  • If an agreement for a Statutory Assessment to commence occurs then only additional information required for the Education, Health and Care Plan (EHCP) will be requested
  • An agreement for an assessment does not necessarily mean that an EHCP will be issued
  • Behaviour alone is no longer a category of SEN under the law and agreement for an assessment will only occur for behavioural needs if the child/young person has severe social, emotional or mental health needs.

Date of Completion:

Name of Student / Pupil:
Address:
DOB: Year Group:
School:
Parent’s / Carer’s Details:
Parent’s / Carer’s Contact Details (If different from above):

All must be recorded / discussed within last 6 months

Tick if included

Aspirations(if elsewhere – indicate where)
Outcomes Required(if elsewhere – indicate where)
Main Needs (if elsewhere – indicate where)

CRITERIA 1:Provision

The child/young person has clear outcomes, based on their and parent(s) aspirations, relevant to the level of need. These have been recordedappropriately and support programmes have occurred using the totality of resources available to the school/college.

Provision: Please provide summary if not recorded elsewhere

Guidance – Possible sources of information: Tick if included

  • ‘Tell Me Once’ approach (required or a background history summary)
  • Guidance of support elements 1 or 2.

There is no need to produce a full cost analysis of all SEN provision, just

that relating to the pupil, either individually or in small groups

Element 1 evidence (potential evidence)

- differentiated lesson plans / whole class approaches

Element 2

-Assess – Plan – Do – Review summaries

-Reviews of Plans

-Person Centred Planning meetings

-Clear outcomes as part of the plans

-Costed provision

-Any specialist equipment

-Other

Element 3

No need for a cost to this but a breakdown of needs unable to be met by

elements 1 and 2

Note: CYP / Parental input must always be outlined or a clear reason stated why it was unable to occur

CRITERIA 2 – Coordinated Approach

The child/young person’s needs have been addressed through a coordinated approach, including use of external services

Evidence Sources

  • Reports from external agencies
  • Copies of person centred meetings

(including input from external agencies)

  • Evidence of how advice has been implemented and the outcomes

of this

  • Evidence of continued involvement of the child/young person

and parents

  • Assess-Plan-Do-Review cycles

(normally at least 2)

  • Any support from the wider community reflected in plans
  • Other

Note: Will always require Educational Psychology input for all cases - Medical if there is a medical need (e.g.: speech and language therapy if this is an area of need, CAMHS if mental health, Social Care if social need, sensory support if a sensory need). All advices should be less than 6months old.

CRITERIA 3: Exceptional, Severe and Complex Needs that are Long Term

The child / young person’s needs are significantly greater than peers of the same age; are long term and require specialist resources or provision to meet long term outcomes.

  • Records of Early Years outcomes / curriculum levels

/ academic attainment (course attainments / progress in phonics)

Indicate which :

  • Log of behaviour over time against interventions (if relevant)

Evidence of….

-Employment, life and social, emotional skills via plans

-Independence skills via plans (if relevant)

-Long term impact of needs (via reports)

-Adaptations required to access the curriculum via plans etc

-Views of child/young person

(could be via Person Centred Planning meeting)

-Views of parent/carer

(would be via Person Centred Planning meeting)

-Resilience / risk factors via plans

-Predicted time-scales to adhere long term outcomes and

Support required (via plans)

-Long term implications if no support for education/employment

via plans

DECLARATION:

This request has been fully discussed and agreed with the child / young person (if aged post year 11/statutory school age), or their parents/carers (if under this age). It has been discussed with the child in an appropriate way if under year 11, and if the student wishes this, with parent/carer post year 11.

They have agreed with it being submitted.

Form completed by:

Designation:

Date:

Signature of parent / carer and/or young person

Date:

Date: