Child's full name
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School
*
Year group
Name of person completing this form
*
Title
*
Role
*
Email
*
Date completed
*
MM
DD
YYYY
School SENCO contact details
*
Please provide details about the child's National Curriculum attainments: (if known)
English : Key Stage 1
Did the child pass the Phonics Test?
If yes, when ?
Speaking and listening
Humanities
P.E
Art
D.T
I.C.T
Reading accuracy
Reading comprehension
Writing
Spelling
Maths
Science
Please detail any recent assessments including test names, dates and results
Does the child have any difficulty with:
Select all that apply
Is there a discrepancy between the child's verbal ability and written work
Is this child being monitored for Special Educational Needs?
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)?
What type of support, if any, is given?
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 yes please give details
Please describe the child's current strengths and difficulties with Literacy
Please describe the child's current strengths and difficulties with Numeracy
Does the pupil have difficulties with memory, attention or concentration?
Attitude to work
Please select all that apply
Are there any current difficulties with speech, oral language or communication?
If yes, please provide further details
Does the child have difficulties with social skills, behaviour, peer relationships or emotional adjustment?
If yes, please provide further details
Does the child have difficulties with self-esteem and confidence?
If yes, please provide further details
Peer relationships
Please select all that apply
Does the child have good organisational skills?
If no, please provide further details
Does the child have any difficulties with fine and gross motor skills e.g. body awareness, movement and balance?
If yes, please provide further details
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
*
First Name
Last Name
Position in school
*
Date completed
*
MM
DD
YYYY
