Head Teacher Request for Statutory Assessment of SEN (SAR.1)
In order that a statutory assessment can be undertaken, the balance of evidence must show that:- the child’s needs have not responded to relevant and purposeful measures by the school and external specialists over a significant period of time, or at least two terms*
- the child’s needs may call for specialist education provision which cannot reasonably be provided within the resources normally available to mainstream schools in the area via the delegated Special Educational Needs formula funding**
Complete all sections. This will help us to respond to your request promptly.
Where key information is lacking in clarity or necessary detail, or is missing from the SAR1: HT and/or the evidence, the request will be returned to the school and the parent/s/carers/s with a letter requesting the required information. This will inevitably create delay, which we would all wish to avoid.
- Pupil Details
First names(s) / Last name
UPN / F / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 1
Any alternative
names(s)
Address
Postcode / Telephone / Sex
Date of Birth / NC Year (of class)
Child in Care / Y / N / Name of allocated social worker
Contact number
Contact address
Child in Need / Y / N
Child Protection / Y / N
Child’s Parent/carer
Address if different from above
Ethnic Group / F/T or P/T timetable:
Please give details in section 4 / Home Language(s)
Disability / Religion
Do parents have any access issues, for example disability or language barrier? Y / N
If Yes please provide details of any additional support requirements or reasonable adjustments that the Authority will need to take into account to support the family through this process.
Name of current school:
CAF Y / N / CAF No
A completed pre-CAF checklist must accompany this evidence / Lead Practitioner
l
IFST (school facing officer)
*External Specialists consulted around making request for Statutory Assessment of SEN
(insert name of professional and name of agency/organisation)
- School Details
School Name / School address and phone number
DfE Number
SENCo (or other person preparing this request)
- Previous School Details (most recent first)
School name inc Authority / From / To
School name inc Authority / From / To
School name inc Authority / From / To
- Attendance – Please ensure that the minimum data supplied covers four academic years
YR / Y1 / Y2 / Y3 / Y4 / Y5 / Y6 / Y7 / Y8 / Y9 / Y10 / Y11
Overall Attendance
Authorised Absences
Unauthorised Absences
If above information is incomplete please state reason(s)
Part time timetable in Place Y / N
If YES please provide/attach re-integration plan.
Please ensure a timetable for re-integration to full time provision is indicated within the plan.
- Health and Medical Issues
Vision* / Speech and Language* / Medical* / Other*
Please provide further details
Hearing* / Physical* / Mental Health
(eg CAMHS)
*Evidenced by CRISP – an agreed summation of assessment in terms of the provision that should be made for a student.
Has the school, with the parent/carers consent notified and sought the assistance of the school nurse and/or the pupil’s general practitioners as appropriate? Y / N
Date and detail around any diagnosis made by medical specialists:
- Social Issues
- Evidence of Need
Date of first IEPor equivalent* at EYA/School Action
Date of last review at EYA/School Action
Outside agencies involved at EYA/School Action (if any)
Summarise the evidence of inadequate progress at School Action which resulted in external support being provided for this pupil at School Action Plus
At Early Years Action Plus/School Action Plus
Date of first IEP or equivalent* at EYA+/School Action Plus
Date of last review at EYA+/School Action Plus
Outside agencies and professional involved at School Action Plus (Please state both the agency and the name of the professional)
Summarise the evidence of inadequate progress at School Action Plus:
* “Inspectors should be aware that while schools are required to review and report progress against the objectives within a statement of special educational needs, there is no statutory requirement for pupils to have IEPs” Para 47 OfSTED . Subsidiary guidance September 2012, No. 110166*
- Evidence of Intervention and Progress at School Action Plus –
- Please provide copies of the last three IEPs or equivalent* with respective review paperwork
- 8a Provide evidence that the pupil’s curriculum has been appropriately differentiated according to any specific programmes/activities/materials/equipment/IT that have been used e.g. monitoring form, observation checklists with patterns noticed and actions taken by class teacher – ‘Wave 2’ interventions.Evidence use of development programme for staff training//strategies e.g. IDP.
- 8b Provide evidence around the school’s responses to the needs of the pupil if they display social and communication difficulties eg social interaction groups, mentoring, circle of friends.
- 8c Provide evidence around the school’s responses to the needs of the pupil for BESD
8 d Provide evidence of provision made at School Action including school staff involved the frequency and timing of support or intervention programmes (Wave 3) and how the intervention has been monitored by the SENCo. Evidence use of the development programme for staff training/strategies e.g. IDP
Please list evidence attached to referral (see guidance notes)
8 e Provide evidence of provision made at School Action Plus including school and external staff involved and how the intervention has been monitored by SENCo and external staff e.g. ‘Evidence of Action’ sheet. Evidence use of developmental programme(s) for staff training/strategies. Evidence use of positive strategies implemented by school for BESD or social communication. Include school provision map (other pupil’s names removed).
Please list evidence attached to referral (see guidance notes)
Name of Professional / Private or LA / Area of specialism / Involved in High Focus Process / Co-Author to Provision Plan / Contribution to CRISP-profile?
If Y indicate Thread(s) / Band supporting
Y / N / Y / N / Y / N
Y / N / Y / N / Y / N
Y / N / Y / N / Y / N
Y / N / Y / N / Y / N
Y / N / Y / N / Y / N
Y / N / Y / N / Y / N
Please ensure a copy of the pupil’s current CRISP-profile is attached reflecting review within the last twelve months
Provide evidence of the involvement of professionals with relevant specialist knowledge and expertise e.g. consultation reports. High Focus supplementary sheets, contribution to High Focus review, contribution as author to Provision Plan, CRISP-profile
Provide evidence of the extent to which the school has followed the advice provided by professional with relevant specialist knowledge:
- Standardised Tests (within the last twelve months)
Standardised Score / Date / Name of Assessment / Administered By / Progress (against previous 12months attainment)
Reading Acc
Reading Comp
Spelling
Maths
TROGG
BG STEEM
APT
SDQ
BAS
Other – insert name of test
Summary of resultsand/or detail around any other assessment information not previously mentioned or narrative around the pupil unable to access standardised assessments.
- Early Years Attainment Data** : Overall EYFS Profile Score
Personal, Social & Emotional Development / Communication, Language & Literacy / Mathematical Development / KUW / PD / CD
D&A / SD / ED / LCT / LSL / R / W / N / Calc / SSM
If incomplete please state reasons (see guidance notes)
**If pupil has been assessed against the new, revised EYFS framework please attach written summary reporting attainment against the ELGs.
- Progress over time: P-scales/NC Levels
PRIMARY PHASE
Year 1 Autumn Term / Year 1 Spring Term / Year 1 Summer Term / Year 2 Autumn Term / Year 2 Spring Term / Year 2 Summer Term / Year 3 Autumn Term / Year 3 Spring Term / Year 3 Summer Term / Year 4 Autumn Term / Year 4 Spring Term
English Reading
English Writing
Maths
Science
PRIMARY PHASE SECONDARY PHASE
Year 4 Summer Term / Year 5 Autum Term / Year 5 Spring Term / Year 5 Summer Term / Year 6 Autumn Term / Year 6 Spring Term / Year 6 Summer Term / Year 7 Autumn Term / Year 7 Spring Term / Year 7 Summer Term / Year 8 Autumn Term
English Reading
English Writing
Maths
Science
SECONDARY PHASE
Year 8 Spring Term / Year 8 Summer Term / Year 9 Autumn Term / Year 9 Spring Term / Year 9 Summer Term / Year 10 Autumn Term / Year 10 Spring Term / Year 10 Summer Term / Year 11 Autumn Term / Year 11 Spring Term / Year 11 Summer Term
English Reading
English Writing
Maths
Science
- Current Assessment. Please give most recent NC scores/teacher assessments
End of Key Stage Assessment / Date / Teacher Assessment / Date
English / Speaking
Listening
Reading
Writing
Maths
Science
**13. Please detail below what you feel a statement of SEN will provide the pupil that cannot be or isn't already being provided and explored in the school.
- Extreme and Urgent Circumstances
We conform:
- The school has been unable to complete all the relevant sections of this
- The evidence will detail the reasons for the request below together with all
support arrangements.
15.Please complete if the pupil has special educational needs, a disability or mobility problem and
cannot reasonably be expected to walk to school accompanied where necessary by their parents
or carers.
1) How is the child currently travelling to school?
2) Do you think additional support is required? Yes No
3) If yes, please tell us why you think travelling assistance is required?
16.Declaration
We confirm:
The pupil is experiencing significant need in the following and meets Birmingham’s criteria for SEN Statutory Assessment referral in:
Main Need / Other Need
Communication and Interaction
Autistic Spectrum Disorder
Cognition and Learning
Behaviour, Emotional & Social Development
Sensory Impairment
Medical Conditions/Physical Needs
Exceptional circumstances where the school has not been able to offer a graduated response
e.g. socially or medically traumatic events such
as road accident, serious illness or abuse,
which are likely to produce lasting learning
difficulties and reduce access to the curriculum
The evidence will detail the nature of the difficulty, will demonstrate that appropriate provision has been made at School Action for a period of not less than two terms and will show that there has not been adequate progress.
The evidence will detail the nature of the difficulty, will demonstrate that appropriate provision has been made at School Action Plus for a period of not less than two terms and will show that there has not been adequate progress.
The evidence will demonstrate that appropriate provision has been made at School Action Plus (High Focus) for a reasonable period of time. (6 weeks minimum)
The contents of this referral have been shared with parents/carers
All Sections of this referral form have been completed in full
Parent and pupils view’s are included and/or reflected in attached
paperwork (see guidance notes)
SENCo signature:
Headteacher signature:
Date:
- Agreement of Parent/Carers
Parent/Carer declaration:
I/we confirm that my/our child’s school has discussed this referral with me/us and I/we have been fully involved in the decision to refer.
I/we understand that a Statement of Special Educational Needs will be agreed by the Local Authority only in circumstances where the statutory assessment process concludes that my/our child has educational needs which are long term, severe and complex.
I/we have worked in partnership with the school to help my/our child.
I/we support the school’s view that a Statutory Assessment of my/our child should be carried out.
I/we understand that if the Local Authority may make a decision not to carry out a Statutory Assessment for my/our child.
Parent/Carer involvement and views- Please include detail below as to what you feel a statement of SEN will provide your child that cannot be or isn't already being provided and explored in the school.
Name(s):
Signature(s):
Date:
Return this form to:
Special Educational Needs Assessment and Review
Directorate of Children, Young People and Families
Lancaster Circus
PO Box 16289
Birmingham
B2 2RS
Head Teacher Request for Statutory Assessment (SAR1) Birmingham City Council