Below is the form I received from my local Council, the one you receive may or may not be different. I requested mine by e-mail, but they also put it in the post, in this day and age it should be possible to get it all off the web and only need posting when necessary! There was useful information included on where to get help filling in the form if you need it.

If you know there are areas where your child needs assistance throughout the day it may not be in their best interests for you leave them out. The idea of 'statements' are to try and ensure that your child's issues are known so they can be tended to as best possible and not to trick you into ensuring your child goes to a 'special' school. However, as with many things the type of services available depend on where you live.

If you do want a statement for your child to be in place before they start school you will need to make the request months before to allow time for the process to be completed.

Keisha was found not to require a statement but the situation is open for review when necessary, either the school or parents can request a review. For further information on statements visit Contact A Family's website

 

Sample form for request of Statement of Special Educational Needs

 

CONFIDENTIAL

Copies of this document will be circulated to all professionals involved with your child.

Appendix A1

 

PARENTS’ VIEWS AND EVIDENCE

 

 for inclusion in the assessment

of my child’s special educational needs.

 

 

Child’s name:         

 

D.O.B.:                      

 

Address:                  

 

Current/most

recent school:        

 

Name of parent(s)/

guardian(s):            

 

Parent(s)’s address

(if different):                                                                                                

 

                                                                                                                       

 

Telephone no.:      

 

Please complete and return this form within 29 days of receipt to:-

 

 

                                   


 

PARENTS’ VIEWS AND EVIDENCE

 

Please feel free to use this form in the best interests of your child.  Leave out sections you think do not apply to your child and add anything you think is important .  Use extra sheets of paper if you wish.

 

Any other evidence you wish to provide may be attached to this report, such as a medical report etc.

 

A.      THE EARLY YEARS

 

1.       What was he/she like as a baby?

 

 

2.       Were you happy with the progress made?

 

 

3.       Did you have any concerns about him/her at that time?

 

4.       Did you receive any advice or help from anyone, if so, whom?

 

 

5.       Did your child go to a nursery or playgroup?  Please tell us how he/she got on.

 

 

 

B. WHAT IS YOUR CHILD LIKE NOW?

 

1. Is your child generally healthy?

 

Does your child have frequent absences from school/playgroup due to minor ailments?

 

 

 

PARENTS’ VIEWS AND EVIDENCE

 

Has he/she spent any time in hospital?  If so, please give details.

 

 

 

Does your child have any special medication?

 

 

 

Does your child have hearing or vision difficulties?

 

 

Are there any other health problems not mentioned above?

 

 

2. Physical skills

 

How good is your child at physical activities, e.g. running, walking, riding a bicycle, football, using playground apparatus?

 

 

How good is your child at drawing, writing, jigsaws, construction kits etc?

 

 

3. Self-help skills

 

How well can your child look after him/herself (e.g. washing, dressing, feeding, going to he toilet, helping in the home, getting about alone)?

 

 

4. Communication Skills

 

How well does your child communicate?  e.g. using signs/gesture, sounds/words/phrases, talking about things that have happened, using the telephone, joining in conversation.

 

PARENTS’ VIEWS AND EVIDENCE

 

Does your child speak English?  What is your preferred language at home?

 

 

5  Play & Learning at home

 

How does your child spend time at home, e.g. watching TV, reading, playing with others or by him/herself.  Does he/she have any hobbies?

 

 

6. Play & Learning outside the home

 

What does your child enjoy doing most, e.g. sporting activities, music, art, group activities,(e.g. Brownies, Beaver, Cubs etc.)?

 

 

 

7. Relationships

 

Does your child prefer to be with other children or on his/her own?

 

 

 

8. Behaviour

 

8a) What is your child’s behaviour like at home?

 

Is he/she cooperative?

 

Is he/she helpful?

 

Does he/she fit in with family life?

 

Does he/she have moods?

 

Is he/she affectionate?

 

Does he/she demonstrate that affection with other family members?

 

Does he/she have tantrums?

 

8b)  What is your child’s behaviour like at playgroup/nursery/school, e.g. does he/she have any difficulty with relationships with teachers and/or children?

 

 

PARENTS’ VIEWS AND EVIDENCE

 

 

9. School Aged Child            NOT YET APPLICABLE

 

Is he/she making progress with reading, writing and other subjects?

 

 

 

 

Has the school helped your child?

 

 

 

 

Has the school asked you to help your child, e.g. homework, listening to your child read?

 

 

 

 

Does he/she enjoy school?

 

 

 

 

What does he/she like about school/not like about school?

 

 

 

 

 

 

Signed:                                  

 

 

 

Name:                                    

 

 

 

Relationship to child:          

 

 

 

Date: