Name of the DOB: Surrey Date ISP Name of Provision Plan. Use this section to explain how you Costing: child: funded implemented: external will support the child hours agencies County they claimed per (No targets involved and live in: week: needed for date of each Stretched(s) the purpose report: Diagnosis if Term time(tt) of this form) Date of known or transition area of Date DLA meeting if concern: agreed applicable: Total Behaviour Support This fund is to enable you to implement a new behaviour strategy involving an additional member of staff for a child. This fund can only be applied for once per child and is payable for up to 8 weeks, calculated from the date of the panel. By completing this section of the application, we will assume that you have discussed this behaviour strategy with the child’s parents and they are in agreement with it and have agreed to a visit from a Supporting Children Advisor to support you. Following the panel you will be emailed a request for support form to complete for the child. Name of Child: DOB: Surrey Behaviour log/ Early What are you worried about? Costing: funded Language Audit/EHA: County they live in: hours (please indicate) How would you use this inclusion fund to claimed per Please state if other support the needs of the child? week: professionals are Stretched involved e.g Children’s (s) Centre Outreach or Term time Family Support Worker (tt)
Name of the child: County they live in: Diagnosis if known or area of concern: DOB: Surrey funded hours claimed per week: Stretched(s) Term time(tt) Date DLA agreed Date ISP implemented: (No targets needed for the purpose of this form) Name of external agencies involved and date of each report: Date of transition meeting if applicable: Provision Plan. Use this section to explain how you will support the child Costing: Total Behaviour Support This fund is to enable you to implement a new behaviour strategy involving an additional member of staff for a child. This fund can only be applied for once per child and is payable for up to 8 weeks, calculated from the date of the panel. By completing this section of the application, we will assume that you have discussed this behaviour strategy with the child’s parents and they are in agreement with it and have agreed to a visit from a Supporting Children Advisor to support you. Following the panel you will be emailed a request for support form to complete for the child. Name of Child: County they live in: DOB: Surrey funded hours claimed per week: Stretched (s) Term time (tt) Behaviour log/ Early Language Audit/EHA: (please indicate) Please state if other professionals are involved e.g Children’s Centre Outreach or Family Support Worker What are you worried about? How would you use this inclusion fund to support the needs of the child? Costing:
inclusion_fund_2018-2019_current_version.docx