My Plan
Insert photo here
Name:
Date of Original Plan:
Date of Amended Plan:
1
Contents
Part 1: All about me
1a
1b
1c
1d
1e
1f
1g
My one page profile
My Details
My story
What people like and admire about me
What is important to me and my family now
What is important to me and my family in the future
My Review (not included in initial plans)
Part 2: Where I am now
2a
2b
2c
2d
My education
My health
My social care
My priorities for the next 12 months
Part 3: My Support Plan
3a
Education, Health & Social Care (linked to Child/ young Person’s
SEND)
3b
Health and Social Care Provision (not linked to Child or Young
Person’s SEND i.e. Safeguarding)
Part 4: Other Health and Social Care Support
Part 5: My Team
Part 6: Education Placement
Part 7: My personal budget
Part 8: Signatures
Part 9: Legal Information
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Part 1 a: My One Page Profile
My full name is:
I like to be called:
Insert Photo here
I was born on:
Things I like:
Things I dislike:
I communicate by:
I am motivated by:
Important things you need to know about
me:
People can help me by:
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1b: My Details
My full name is:
I like to be called:
My date of birth is:
My address is:
The people in my family/life are:
The person with parental responsibility is:
Contact details Tel and email:
The best times to contact the above person are:
1c: My Story
4
1d: What people like and admire about me
1e: What is important me and my family now?
1f: What is important to me and my family in the future?
5
1g: My Review
(Only applicable after initial plan)
This page of the plan refers back to section 3 of the previous plan dated xx/xx/xxxx.
Please copy and paste previous targets and then state whether they have been achieved
and make any comments as appropriate.
No.
1
Target
Achieved?
Yes No
Partially
2
Yes No
Partially
3
Yes No
Partially
4
Yes No
Partially
5
Yes No
Partially
6
Yes No
Partially
7
Yes No
Partially
8
Yes No
Partially
Comments?
6
Part 2: Where I am now
2a: Education
Assessment information
Cognitive assessment:
Language assessment:
EYFS/National curriculum levels:
Other:
What is going well and /or needs to
continue:
Cognition and Learning:
What is not going so well and / or
needs to change:
Communication and Interaction:
Social, Mental and Emotional Health:
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2b: Health
Assessment information:
Height:
Weight:
Vision:
Hearing:
What is going well and /or needs to
continue:
Medical:
What is not going so well and / or needs to
change:
Physical:
Sensory:
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2c: Social care
Assessment information
What is going well and /or needs to
continue:
Independence:
What is not going so well and / or needs to
change:
Family life:
Other:
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2d: Key priorities for me and my family over the next 12
months:
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Part 3: My support plan
3a: Education, Health & Social Care (include here any provision required by
education, health and social care where the provision is reasonably required by the learning difficulties and
disabilities which result in this child/young person having special educational needs)
Longer Term Outcome Sought
By when?
1
Shorter Term Outcomes Linked To Above
By when?
1a
1b
1c
What support and provision is required to help achieve the above
outcomes (including the frequency)?
Who is
responsible?
11
Longer Term Outcome Sought
By when?
2
Shorter Term Outcomes Linked To Above
By when?
2a
2b
2c
What support and provision is required to help achieve the above
outcome/target (including the frequency)
Who is
responsible?
12
Longer Term Outcome Sought
By when?
3
Shorter Term Outcomes Linked To Above
By when?
3a
3b
3c
What support and provision is required to help achieve the above
outcome/target (including the frequency)
Who is
responsible?
13
Longer Term Outcome Sought
By when?
4
Shorter Term Outcomes Linked To Above
By when?
4a
4b
4c
What support and provision is required to help achieve the above
outcome/target (including the frequency)
Who is
responsible?
14
3b: Health & Social Care Provision
(include here any provision required by health and social care where the provision is not
linked to the Child or young person’s Special Educational Need i.e. safeguarding)
15
Part 4:
Name
My details
The following people helped contribute to writing this plan:
Role
Address
Email
Phone
Written
number
advice
included in
appendices?
Part 5: Education Placement
Name of Education Establishment:
Type of Education Establishment:
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Part 6:
My personal budget
17
Part 7: Signatures
Name
Role
Child/young person
Signature
Parent/carer
Parent/carer
Duly Authorised Officer
Education
Duly Authorised Officer
Health
Duly Authorised Officer
Social care
Part 8: Legal information
Include arrangements for monitoring progress
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