Form for Primary school

An assessment is being carried out to clarify this child’s learning, emotional and/or behavioural needs. Information from school will be very useful and help to provide a wider context in which to place these needs. If this assessment is required to potentially be used as part of an application for exam access arrangements, then we would strongly advise that school supply information about the individual's normal way of working within this environment which will ensure that any recommendations for support in exams reflect this. Your support is therefore appreciated. Please do not complete this before you have been in contact to arrange an assessment. All information will be treated confidentially.

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Child's full name School Year group Name of person completing this form Title Role Email Date Completed School SENCO contact details

School Performance

Please provide details about the child’s National Curriculum attainments: (if known)

English: Key Stage 1 English: Key Stage 2 Maths: Key Stage 1 Maths: Key Stage 2 Science: Key Stage 1 Science: Key Stage 2

Did the child pass the Phonics Test?

Yes No

If yes ,when ?

End of year one End of year two

Provide details on the child's current level

Speaking and listening

Below Average Average Above Average

Humanities

Below Average Average Above Average

P.E

Below Average Average Above Average

Art

Below Average Average Above Average

D.T

Below Average Average Above Average

I.C.T

Below Average Average Above Average

Reading accuracy

Below Average Average Above Average

Reading comprehension

Below Average Average Above Average

Writing

Below Average Average Above Average

Spelling

Below Average Average Above Average

Maths

Below Average Average Above Average

Science

Below Average Average Above Average

Please detail any recent assessments including GCSE's and results

Provide details on the child's current level

Does the child have difficulty with... (select all that apply)

Planning and organising written work Getting started with written work Copying from the board

Is there a discrepancy between the child’s verbal ability and written work?

Yes No

Is this child being monitored for Special Educational Needs?

Yes No

Is there an individual Education Plan (IEP)/Personalised Learning Plan (PLP)?

Please detail any current support/provision this child is receiving If Yes, Who gives this support (role in school)? Give details on the length/frequency of session(s) Please provide evidence/information of the child’s normal way of working and relevant background information if this assessment is to be used as evidence for exam access arrangements. Has this child been discussed/assessed/monitored by any external agencies, e.g. Educational Psychologist, Behaviour support, Learning support etc. If the child has an Educational Health and Care Plan, please attach a copy of the most recent Annual Review or other relevant information

Please describe the child’s current strengths and difficulties with Literacy

Please describe the child’s current strengths and difficulties with Literacy

Does the child have difficulties with memory, attention or concentration?

Attitude to work

Select all that apply

Are there any current difficulties with speech, oral language or communication?

Does the child have difficulties with social skills, behaviour, peer relationships or emotional adjustment?

Does the child have difficulties with self-esteem and confidence?

Peer relationships

Select all that apply

Does the child have good organisational skills?

Does the child have any difficulties with fine and gross motor skills e.g. body awareness, movement and balance?

Please provide information about the child’s strengths, what they are good at school and what they enjoy doing

Please provide any other information that would be useful for the assessor to know and what you hope to get out of the assessment

Signed Date completed