FA2 (09/14)
Requesting a Statutory Education, Health and Care Assessment for your child
Information for Parents / Carers
Please note that this form is only for Islington residents. If your child attends an Islington school
but lives outside Islington, please contact the SEN service in your home borough.
Most children will have their needs met from the services that are normally available locally. You can find
details of these services through Islington’s ‘Local Offer’ : www.islington.gov.uk/localoffer.
A statutory Education, Health and Care assessment is something that will only be considered if, despite
access to all of the available local services and supports, your child is not making the progress that they
may be capable of. This will apply to a very small number of children.
It is usually a school or early years setting that asks for a statutory Education, Health and Care
assessment. Very occasionally, parents decide to request this assessment themselves. This is usually
when a child is not attending school or early years setting, or if the school or setting does not agree that
such an assessment is needed.
Where we receive a request, the first decision (whether to carry out an assessment) will be taken within
4 weeks. All of the information we are given with a request is looked at carefully by a multi-agency group
of senior officers from education, health and care. They will be looking for evidence that all the services
that are available to all children been made available to your child in the proper way, and if so, what
impact they have made.
It will helpful if you can provide as much of this information as possible so that a proper decision about
your request can be reached. If you do decide to make a request yourself, please use the form below.
You may want to ask an independent parent support worker from Centre404 (a local voluntary
organisation who offer a Parent Carer Support Service) to help you fill it in. They can be contacted on
020 3316 1930.
When you have completed this form please return it, together with any relevant reports to:
Special Educational Needs
Pupil Services
222 Upper Street
London N1 1XR
Email: sen@islington.gov.uk
Tel:
020 7527 5518
When we receive your request, we will contact your child’s school or early years setting, Health and
Social Care to find out if they have any information that we need to know. A SEN Keyworker will also
make contact with you.
Please note that by signing this form on page 5, you are giving your consent for us to obtain and share
information about your child with relevant professionals so that we can make a proper decision about
your request.
SECTION 1:
Your Child’s Details
First Name
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Surname
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Date of Birth
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Gender
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Ethnicity
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First Language
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Address
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School
(or Early Years setting)
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Year Group
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Have you discussed this request for an assessment with your child’s
school or Early Years setting?
SECTION 2:
Your details
Title
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First Name
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Surname
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Relationship to child
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Address
(if different to your child)
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Email Address
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Telephone Number
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SECTION 3:
Choose an item.
Details of anyone else who has parental responsibility for you child
Title
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First Name
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Surname
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Relationship to child
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Address
(if different to your child)
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Email Address
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Telephone Number
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SECTION 5:
Your Child’s Needs
Your child’s Needs
Why are you asking for a statutory Education, Health and Care assessment? What are you worried
about?
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Is there anything else you want to tell us that isn’t covered above?
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SECTION 3:
Supporting Documentation
Please provide the following supporting documentation by scanning, attaching and returning it
with this completed form.
Please code each document that you send us with the corresponding letter below e.g. ‘Most
recent report from an Education Psychologist’ should be coded with the letter A.
Please note that a request for a statutory Education, Health and Care Assessment cannot
be considered until all the documentation listed has been received; any incomplete
request will be returned.
Please tick to
confirm you
have included
this information
For office
use only
A.
Most recent report from an Educational Psychologist
employed or commissioned by the Local Authority.
☐
☐
B.
Completed CAF (Early Help) assessment.
☐
☐
☐
☐
Any other specialists’ advice (e.g. Occupational Therapy,
Physiotherapy, Speech and Language Therapy Services,
CAMHS, Paediatrician, Children’s Social Care) that is
relevant to the child’s learning and development.
Please list reports below, referenced appropriately (i.e. C1,
C2 etc.):
C.
Click here to enter text.
Please tick to
confirm you
have included
this information
D.
Details of the education provider’s current arrangements
(costed) which are additional to or different from what is
normally available through the differentiated curriculum for all
children.
For office
use only
☐
☐
☐
☐
Copy of the current and most recent individual plan (e.g.
Individual Education Plan, Pupil Passport, SEN Support Plan)
or provision map, which should include:



E.


Evidence of baseline assessment from which
progress can be measured
Records of regular reviews and their outcomes
Details of parent / carer involvement (e.g. home
school agreements, reviews)
Strategies used beyond differentiation which are
additional to or different from those normally available
Additional resources made available to enable the
child to achieve targets
(If the individual plan / provision map does not include all
of the elements above, separate documentation must be
submitted)
F.
Most recent End of Year Report (if not included above)
☐
☐
G.
Attendance details for the last three terms.
☐
☐
H.
Child’s views, if not already recorded in other supporting
documentation.
☐
☐
☐
☐
Please list all professionals whose advice should be included
as part of an Education, Health and Care Assessment, if
agreed.
I.
Click here to enter text.
SECTION 6:
Request for Statutory Education, Health and Care Assessment
I confirm that I am requesting a statutory Education, Health and Care assessment of my child’s needs. I
understand that the Local Authority must seek advice from an Educational Psychologist, Social Care,
Health and other professionals supporting my child’s learning and development and I give my consent
for relevant information to be shared.
Name
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Signature
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Date
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Please return this form, together with any reports from people involved in working with your child,
including the most recent report from their school or early years setting to:
Special Educational Needs, Pupil Services, 222 Upper Street, London N1 1XR
E mail:
sen@islington.gov.uk
Tel:
020 7527 5518