l. Does the child/young person Yes Yes Yes Yes Yes No No No No No have a disability or an Don’t Know Don’t Know Don’t know Don’t Know Don’t know additional need? Briefly explain the impact on the child/young person of having a disability or additional need: m. Does the child/young SEN support SEN support SEN support SEN support SEN support person have a Special Educational Need? If so, what Higher needs Higher needs Higher Higher Higher needs level of support do they Funded (what Funded (what Funded (what Funded (what Funded (what receive? (please tick relevant type) type) type) type) type) Statement or Statement or Statement or Statement or Statement or box) EHC Plan EHC Plan EHC Plan EHC Plan EHC Plan Education, Health and Care (EHC) Plan 5. Adults in this home and adults who do not live with the child/young person but are important to them: 1 2 Adult 3 Adult 4 Adult 5 a. First name b. Surname c. Also known as d. Date of birth (DD/MM/YYYY) if known e. Gender Adult 1 Adult 2 Adult 3 Adult 4 5 f. Relationship to each
l. Does the child/young person have a disability or an additional need? Yes Yes Yes Yes Yes No No No No No Don’t Know Don’t Know Don’t know Don’t Know Don’t know Briefly explain the impact on the child/young person of having a disability or additional need: m. Does the child/young person have a Special Educational Need? If so, what level of support do they receive? (please tick relevant box) Education, Health and Care (EHC) Plan SEN support SEN support SEN support SEN support SEN support Higher needs Funded (what type) Higher needs Funded (what type) Higher Funded (what type) Higher Funded (what type) Higher needs Funded (what type) Statement or EHC Plan Statement or EHC Plan Statement or EHC Plan Statement or EHC Plan Statement or EHC Plan 5. Adults in this home and adults who do not live with the child/young person but are important to them: 1 2 Adult 3 Adult 4 Adult 5 a. First name b. Surname c. Also known as d. Date of birth (DD/MM/YYYY) if known e. Gender Adult 1 Adult 2 Adult 3 Adult 4 5 f. Relationship to each