INDIVIDUAL SSAP Referral

INDIVIDUAL SSAP (SEND Support Advisory Partnership) Referral Form

Working Together for Early and Effective SEND Support. This referral form is part of the SEND Support Advisory Partnership (SSAP), a multi-agency approach designed to help education settings in Sutton access advice, resources and additional support to meet pupils’ SEND needs at the earliest stage.

Section 1

Email(Required)

Section 2

Individual SSAP Referral

Uploaded parental/carer permission(Required)

Max. file size: 120 MB.

PLEASE NOTE: Where schools wish to refer an individual pupil to the SEND Support Advisory Partnership (SSAP), parental/carer consent is required prior to submission. For any issues, please email ssap@cognus.org.uk

Full name of pupil(Required)

Name of setting(Required)

Date of birth(Required)

MM slash DD slash YYYY

Year group of pupil(Required)

Please select from the drop down list

If you have selected ''Other'' please add details

Name of referrer(Required)

Role of referrer(Required)

Start date at setting(Required)

MM slash DD slash YYYY

Is the pupil a Sutton resident(Required)

Yes

Pupil's postcode(Required)

Post Code

Name and address of pupil's GP(Required)

Street Address Address Line 2 City County Post Code

Pupil's Ethnicity(Required)

Pupil's first language. Please detail if there are EAL needs(Required)

Please indicate if the pupil is(Required)

Child in Need/Child Protection

Child Looked After

Under an SGO or in Kinship Care

The family are open to Early Help

None of the above

SEN status (please note SSAP is intended as pre-statutory support only)(Required)

SEND Support

EHCNA submitted but no response yet

EHCNA received a no to assess/issue

No SEN

Current attendance levels of the pupil (last term)(Required)

Please detail any suspensions or exclusions the pupil has received

Please detail the pupil's timetable i.e., if they are attending on a reduced timetable and reasons why

Is the school in receipt of any additional funding for this pupil?(Required)

Reception Transition funding

EHCP funding

ASC (additional support contract)

Targeted funding from SENCO Cluster

No additional funding this academic year

Other

If you have selected ''Other'' please add details

Has the setting previously received any additional SEND funding for this pupil? Please list the type of funding, time frame of funding and amount?(Required)

Is the pupil known to any other multi-agency support groups/panels?(Required)

VPP

Helping Early

Early Years Operational Group

None known

Other

If you have selected ''Other'' please add details

Details of other agency involvement (e.g., safeguarding, social care, CAMHS, Educational Psychology, Inclusion, Therapies, Attendance, EY team, HaVES etc. If there has been no involvement, please add N/A to the box.(Required)

Please attach pupil's attainment and progress over time from school tracking data.

Drop files here or

Max. file size: 10 MB, Max. files: 5.

Please describe your concerns regarding the pupil. Give key details and examples where appropriate.(Required)

Has the setting implemented the Sutton ordinarily available provision guidance (OAP) and reviewed the impact over time?(Required)

Yes

Please detail what OAP has been implemented to support the pupil. If there has been no OAP implemented, please add N/A to the box.(Required)

Please check the boxes that best describe the needs of the pupil (multiple boxes can be checked)(Required)

Cognition and Learning

Autism/Social Communication

SLCN

Mental Health

ADHD

Physical Development

Medical Needs

Hearing Impairment

Visual Impairment

Multi Sensory impairment

Other

If you have selected ''Other'' please add details

Please provide a summary of the pupil's emotional and mental well-being.(Required)

What support are you are seeking from SSAP?(Required)

Strategies and advice about an individual pupil

Direct support from an external professional e.g., consultation, assessment

Staff training

Additional resources

Additional funding because notional funding has been exhausted

Signposting

Strategies and advice about a particular type of need in my school

Funding for a high needs pupil who is a new arrival

Other

If you have selected ''Other'' please add details

Section 3

Direct support from a professional or staff training

If seeking direct support from an external professional or staff training please clearly outline your request. If a specific training has already been identified please name and link the training course where possible, if costings are available please include these, otherwise please add N/A.(Required)

If you have completed the box above, please go to section 5

Section 4

Additional resources or funding

If seeking additional resources or funding, please clearly outline what these resources are and how they will be utilised to support the pupil, otherwise, please add N/A to the box(Required)

If you have completed the box above, please go to section 5

Section 5

Supporting documents

Please attach a completed Edukey provision map, including costings. (Referrals will not be accepted without attachments)

Drop files here or

Max. file size: 10 MB, Max. files: 5.

Please attach the pupil's most recent end of year school report, if available

Drop files here or

Max. file size: 10 MB, Max. files: 5.

Please attach any recent reports e.g. EP, SALT etc.

Drop files here or

Max. file size: 10 MB, Max. files: 10.

Section 6

Responsibility statement

It is the schools responsibility to request parent/carer's permission to make a referral for support from SSAP. Please confirm that: – The parent/carer agrees to the involvement of the SEND Support Advisory Partnership (SSAP) including a multi-disciplinary group discussion and onward referrals where appropriate. – The parent /carer agrees to this information being held by Cognus Ltd. on behalf of the Local Authority and agrees to the sharing of reports and information with other professionals and other agencies as necessary. Please refer to https://cognus.org.uk/about-us/gdpr/ for further information regarding data protection.(Required)

Yes, parents/carers have formally agreed with school in writing and evidence of this can be provided

No parental permission has not been agreed (requests will not be accepted without parent/carer permission)