Themes: Education for all (Inclusion), Special Educational Needs & Disabilities (SEND) SSAP Referral Form SSAP (SEND Support Advisory Partnership) Referral Form Section 1Referral Email(Required) 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 Are you requesting SSAP support for an individual pupil? Yes Are you requesting SSAP support for a group of pupils? Yes Section 2Individual SSAP ReferralFull name of pupil(Required)Name of setting(Required)Date of birth MM slash DD slash YYYY Year group of pupil(Required)ReceptionYear 1Year 2Year 3Year 4Year 5Year 6Year 7Year 8Year 9Year 10Year 11Year 12Year 13Year 14OtherName of referrer(Required)Role of referrer(Required)Start date at setting(Required) MM slash DD slash YYYY Is the pupil a Sutton resident Yes No 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 receivedPlease detail the pupil's timetable i.e., if they are attending on a reduced timetable and reasons whyIs 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 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 Details of other agency involvement (e.g., safeguarding, social care, CAMHS, Educational Psychology, Inclusion, Therapies, Attendance, EY team, HaVES etc.(Required)Please attach pupil's attainment and progress over time from school tracking data.(Required) Drop files here or Select files 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 No Please detail what OAP has been implemented to support the pupil(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 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 Section 3Funding for a high needs pupil who is a new arrivalIf 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(Required)Section 4Additional resources or fundingIf seeking additional resources or funding, please clearly outline what these resources are and how they will be utilised to support the pupil(Required)Section 5Supporting documentsPlease attach a completed Edukey provision map, including costings. (Referrals will not be accepted without attachments)(Required) Drop files here or Select files 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 Select files Max. file size: 10 MB, Max. files: 5. Please attach any recent reports e.g. EP, SALT etc. Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Section 6Group SSAP ReferralsNames, year groups and DOBs of the pupils included as part of this group request(Required)SEND status of the pupils in this group request(Required) SEND Support No SEN A combination of SEND Support and No SEN Do any of the pupils in your request have an EHCP or are any going through the EHCNA process?(Required) Yes No Received a no to assess/issue Are all pupils within the group request Sutton residents? (Please note funding can only be provided for Sutton resident pupils)(Required) Yes No Mix of Sutton and non-Sutton residents but not a funding request Do any of the pupils have other agency involvement e.g., safeguarding, social care, CAMHS, EP, Inclusion, Therapies, Attendance, EY team, HaVES etc. Please name the pupil and the agency and give a brief summary(Required)Are any of the pupils also known to any other multi-agency groups or panels?(Required) VPP Helping Early EY Operational Group None known Please attach pupils' attainment and progress over time from school tracking data.(Required) Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Please summarise your concerns for the group(Required)Has the setting implemented the Sutton ordinarily available provision guidance (OAP) and reviewed the impact over time? Yes No Please detail what OAP has been implemented to support the group.(Required)Please check the boxes that best describe the needs of the pupils' in the group (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 Please provide a summary of the pupils' emotional and mental well-being(Required)What support are you are seeking from SSAP?(Required) Strategies and advice Direct support from an external professional e.g., consultation, assessment Staff training Additional resources Additional funding because notional funding has been exhausted Signposting Other Section 7Group additional resources or fundingIf seeking additional resources or funding, please clearly outline what these resources are and how they will be utilised to support the pupils(Required)Section 8Group direct support or staff trainingIf 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(Required)Section 9Group supporting documentsPlease attach a completed Edukey provision map, including costings. (Referrals will not be accepted without attachments)(Required) Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Please attach the pupils' current support plans or pupil passports(Required) Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Please attach any recent reports e.g. EP, SALT etc(Required) Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Section 10Responsibility statementIt 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)
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