GRIP PANEL REFERRAL FORM PUPIL: PUPIL ID NO: DOB: YEAR GROUP: DFES NO: CURRENT PLACEMENT: DATE REFERAL RECEIVED: LOCALITY: North SOUTH CIC: Yes No Section 1 Does the request clearly identify the child’s barriers to learning and participation? No refuse application – Yes proceed to Section 2 – Section 2 Does the request contain a detailed and appropriate Provision Map explaining how the school is using all of their £6,000 delegated funding, listing specific interventions matched against the identified barriers to learning and participation? No refuse request – Yes proceed to Section 3 –
GRIP PANEL REFERRAL FORM PUPIL: PUPIL ID NO: DOB: YEAR GROUP: DFES NO: CURRENT PLACEMENT: DATE REFERAL RECEIVED: LOCALITY: North SOUTH CIC: Yes No Section 1 Does the request clearly identify the child’s barriers to learning and participation? No – refuse application Yes – proceed to Section 2 Section 2 Does the request contain a detailed and appropriate Provision Map explaining how the school is using all of their £6,000 delegated funding, listing specific interventions matched against the identified barriers to learning and participation? No – refuse request Yes – proceed to Section 3
grip-panel-referral-form.docx