EDUCATION ASSESSMENT TOOL
(Schools/Settings Request to Assess)
Name of Child:
Date of Birth:
Name of Setting /School/
Post-16 Provision:
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Pre-Request to Assess Checklist
Prior to submitting a Request to Assess, please use the checklist below to demonstrate
that you have followed the staged approach as set out in the accompanying guidance
document.
If the approach has been followed and progress has not been made as expected/needs
are not met, then please complete and submit the Request to Assess form.
Approach
followed
– Y/N
First step
Inclusive quality-first teaching
Ensure high-quality teaching, differentiated for
individual pupils, is in place
Second
step
Access Local Offer
Sign posts the levels of support and provision
available to CYP with or without and EHC Plan
Third step
Review current support
 Are the needs of the child/young person severe
and complex?
 Have the barriers to learning/inclusion been
fully identified and appropriate action taken to
remove or minimise these barriers?
 How has extra support from the school’s own
resources been used and for how long?
 Use of Banded Funding to ‘top up’ school’s
own resources.
 Use of external services for SEN support
(previously School Action)
 Involvement of parents/carers.
 Involvement of child/young person.
 What progress has been achieved so far?
Progress
made as
expected
– Y/N
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SECTION 1 - CHILD/YOUNG PERSON’S PERSONAL
DETAILS
First Name(s):
Surname:
Address
Postcode:
Date of Birth:
Age:
Gender:
YES
NO
Looked After Child:
YES
Child in Need:
Unique Pupil Number:
NHS Number (if known):
CareFirst ID (if known):
Integrated Youth Support System
(IYSS) ID (if known):
Name of Setting /School/
Post 16 Provision:
Date of Admission to school:
National Curriculum Year Group:
Previous Schools Attended (if known):
Date Education Assessment Tool
Completed:
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NO
SECTION 2 - PARENT / CARER PERSONAL DETAILS
Parental
Responsibility:
Relationship to
child:
Address:
Postcode:
Contact
Number(s):
Email
Contact(s):
Ethnicity:
Religion:
Language Spoken at Home:
SECTION 3 – AREA OF NEED AND FINANCIAL SUPPORT
Area(s) of Need (please indicate as appropriate):
ASD
BESD
PMLD
SLCN
SLD
VI
MLD
HI
PD
Top Up Funding Allocation:
Band
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SECTION 4 – SUPPORTING EVIDENCE
a) CORE EDUCATIONAL ADVICE AND INFORMATION:
Document/Plan/Assessment
Yes
If no, please provide further
Information
Educational Psychology
Child’s individual learning plan
Locke and Beech Profile Report (where
appropriate)
Annual School Report
Child’s Timetable and Support
Child’s/Young Person’s Views on their
educational needs
Parents’ Views on their child’s
educational needs and support
b) ADDITIONAL EDUCATIONAL SUPPORT AND ADVICE:
Document/Plan/Assessment
Yes
No
Further Information
Early Years SEN Inclusion Team
S2S Advice
Autistic Spectrum Disorder (ASD) Team
Hearing Impaired (HI) Team
Visually Impaired (VI) Team
MAST
Primary Inclusion Centre / Sheffield
Inclusion Centre
Other interventions (please detail as
appropriate)
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c) HEALTH ADVICE AND INFORMATION:
Document/Plan/Assessment
Yes
No
Further Information
HealthCare Plan
Continuing Healthcare
Medical Conditions/Formal Diagnosis
Other Interventions (please detail as
appropriate)
d) SOCIAL CARE SUPPORT AND INFORMATION:
Document/Plan/Assessment
Yes
No
Further Information
Personal Education Plan (PEP)
Family CAF
Other Interventions (please detail as
appropriate):
Name of professional making this request:
Name
School/service/agency
Date of request
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SECTION 5 – CONTEXT WITHIN EDUCATIONAL SETTING
Descriptive Summary
The Past (building a picture: birth, diagnosis and significant life events)
The Present (Important people in the child/young person’s life, current living situation,
support needs, support arrangements, likes, dislikes…..)
The Future (aspirations for the future and support towards developing independence)
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INFORMATION AND SHARING CONSENT
Parental/Young Person Consent
I agree to an EHC needs assessment for (child’s name) ………………………………
…………………….. (this includes collection of educational, health and social care advice).
I agree to all professional reports submitted as part of the request for an EHC needs
assessment for (child’s name)……………………………………………………………….
being shared with other professionals to support this process.
As part of the needs assessment, I agree to my child, (child’s name)…………………
………………………………………… being seen by an Educational Psychologist and/or a
Doctor, for the purpose a EHC needs assessment.
I have been told that personal information will be used through Sheffield City Council’s
involvement with (child’s name)…………………………………………….. to help make
decisions and provide services.
I understand that Sheffield City council will share the minimum necessary information
between people and organisations providing services that (child’s name) ……………
………………………………………….is using, or is likely to use.
Name (please print)
Signature
Date
Parent
Child/Young Person
(where applicable)
If there is any information or advice that the Local Authority may gather during the
Education, Health and Care Needs Assessment that you wish to remain
confidential, please give details below or contact the SEN team.
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