Forms home Single point of access referral form for education support Please read the privacy statement to know about how we will use your information Privacy Policy Step 1 of 11 9% Evidence of parent / carer permission must be provided with this referral. At least one contact number should be supplied before we can accept the referral. Section 1 - person making the referral / requestFirst name(Required)Last name(Required)Job title(Required)Email(Required) School / setting(Required)Department(Required)Address(Required) Address Line 1 Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Are you referring only for training?(Required)YesNo Section 2 - child / young person’s detailsStudent’s first name(Required)Student’s last name(Required)Gender(Required)FemaleMaleDate of birth(Required)Address(Required) Address Line 1 Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Home telephoneParent’s / carer’s mobileYoung person’s mobile number (if over 16yrs)Does child / young person receive Pupil premium DLA/ PIP Nursery / school / college(Required)School year(Required)Attending(Required)Choose an itemFull timePart timeNot in schoolNever been to schoolAttendance at another settingOtherIf part time(Required)1/2 days sessionsless than 1/2 daysLanguageInterpreter requiredYesNoReligionEthnicityNationalityNHS number (where known)GP nameGP address Address Line 1 Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Is child / young person EHCP LAC known to Children and Disabilities Team school SEND support subject to Child Protection / Child in Need Plan Date moved into RedbridgePrevious local education authorityKey medical needs School health care planYesNoPlease uploadAccepted file types: jpg, png, pdf, doc, docx.Any other information Section 3 - parent's / carer’s detailsWho has parental responsibility?(Required)Parent’s / carer’s full name(Required)Address(Required) Address Line 1 Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode Relationship to child / young person(Required)Interpreter requiredYesNoPreferred method of contact(Required)PhoneEmailTelephone(Required)Email(Required) Preferred contact timeMorningAfternoonEither Section 4 - other services / professionals involved (current and past). Please select all services involved in each sectionEarly years Pre-school home visiting team Early years advisory service Health visitor Other Please specify(Required)Outreach Hatton Little Heath Churchfield’s Lang Outreach New Rush Hall Newbridge SERC equipment VI Advisory Service HI Advisory Service Other Please specify(Required)Other Education services Home tuition Educational Psychologist Education Welfare Officer Other Please specify(Required)Health SALT Paediatrician Occupational Therapist Physiotherapist Community Nursing Team Continence Team Feeding SALT Referral made to CDC (Child Development Centre) EWMHS (previously known as CAMHS) Other Please specify(Required)Other Youth Offending Team Fusion YP - Substance Misuse Service Social Care Connections Other Please specifyPlease list all involvement from outside professionals in the past 12 months, and the outcome of their involvement / recommendations Involvement Outcome Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Is this student a transition student?YesNoWould you like support with this?(Required)YesNo Section 5 - reason for referralReason for referral(Required)Choose an itemAssessmentDirect supportEHCP supportTransitionTraining and advice for a specific studentSERC ICT assessmentBlock of support eg yr 1 lang programme. motorPlease identify the key area of need(Required)Choose an itemAutistic spectrumSocial communicationReceptive languageExpressive languageAttention and listeningGlobal learning difficultiesCognition and learningSPLD ie memory, organisationHearingVisionPhysical disability/ physical access to learningMotorMedical needsAuditory processing disorderSEMHComplex needsAdditional needs Autistic Spectrum Social Communication Receptive Language Expressive Language Attention and Listening Global Learning Difficulties Cognition and Learning SPLD ie Memory, organisation Hearing Vision Physical Disability / Physical Access to learning Motor Medical Needs Auditory Processing Disorder Multi- Sensory SEMH Complex Needs Any other information. Including any formal diagnosis (please evidence where possible)Evidence (optional) Drop files here or Accepted file types: jpg, png, pdf, doc, docx. Section 6 - developmental history (where known)Key developmental milestones. eg began speaking, first steps, independently sitting etc Please use the "+" button on the right to add next key developmental milestoneDate of last eye testOutcome of last eye testDate of last hearing testOutcome of last hearing test Section 7 - assessment detailsPlease list current learning levels. These must include core subject areas Learning level Core subject area Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Interventions / strategies past and present including outcomes of these (assess, plan, do and review). Please indicate all school support, external interventions and specialist provisionPlease attach provision map / timetable or school data if this is easier to summarise Drop files here or Accepted file types: jpg, png, pdf, doc, docx. Section 8 - parental concerns and relevant family historyParental concerns / views on the referralAdditional information the family would like to be shared Section 9 - child / young person’s viewsChild / young person’s views on the referral Section 10 - permissionsPlease tick to confirm you have read and understood the following involvement. I understand the SENCO / other professional will request support / advice/ assessment from S.E.A.T.S.S. Following a referral, a member of the Team may visit your son / daughter in pre-school / school / college.Consent(Required) By checking this box you confirm that you have read, understood and agree to the involvementDuring this visit I understand and I give permission for a member of the Team to Select All Visit the school / setting Obtain data. Medical information (where relevant), talk to key members of staff to ascertain a full picture Observe / work directly with your child The personal information we gather is only used by us to help your child at school and at home. It will only be shared with you, the school and directly with relevant professionals. We use the information gathered to write reports, make suggestions for the school (if any) and you. The information is stored on a secure internal database. By default, we retain it until your child is 25 years old. You may request a copy of all information we retain at any time and ask for it to be deleted or amended Work with my child in class or outside class if the assessment requires it Take photos / videos of my child during the assessment and the photos will be added to the report. Any unused photos will be destroyed at the time of report writing I agree to share hospital information (if relevant) I understand that as my Child moves through Education, their needs or the focus of support may change, and they may receive support from additional teams Full name(Required) Section 11 - trainingTeams have prepared INSET sessions, but also we can create bespoke packages for your schoolPlease tick all areas you are interested in Whole school CPD Specific CPD sessions LSA training Parent’s sessions Specific blocks of support / interventions Please select Primary Secondary Other Would it be just your staff or would you be inviting staff from other schools?Choose an itemJust my school/ settingWe may invite other schools/ colleaguesHave you had training in this area before?Choose an itemYesNoWould you be interested in a multi- disciplinary training day / session?Choose an itemYesNoMaybeAre there any other topics / format you would like to consider?Areas of training currently offered – please select which you require 5P (accredited training) 6 week block of motor support (gross and fine motor) Access arrangements AET (accredited training) App’s to support a range of curriculum areas/ needs Autism Autism – a personal perspective Back care of parents Back care of staff Behaviour / 5P scale BSL- family training Can’t write/ won’t write Class disability awareness session Coaching and mentoring Disability awareness assemblies Colourful semantics Communication Developing conversation / communication skills Developing tray independence Down’s syndrome Engagement profile Fine and gross motor training including happy hands, healthy hands Hearing Impairment training Incredible 5 point scale Makaton (accredited training) Mental health first aid Motor and life skills – readiness for school (nursery / pre-school) Moving and handling (accredited training) Neurological profile and the impact on the learner Numicon PD net level training PEEP’s and risk assessments Pre- stage standards Precision teaching Revision strategies and techniques SEN classroom support Sensory learning Social stories Specific condition eg dystrophy, cerebral palsy, spina bifida Specific language impairment Steps to being a writer – pre writing, alternatives forms of recording Strategies for Inclusion Study skills / memory (secondary) Talkabout Teenage talkabout Using ICT to support literacy and dyslexia Using ICT to support non-verbal students Using ICT to support visual Impairment Visual impairment training Working with additional needs Working with students working at lower P scales Primary schools only Early English language learners (listening programme) Good listening programme Narrative programme Parents workshop language / communication session nur / rec / yr 1 Reading workshop Supporting students who have speech, language and communication needs Yr 1 language project 10 week programme Other training not listed above, please specify