8 Authorisations – 8a Headteacher/Manager/Principal I confirm that, having followed the procedures outlined in the Code of Practice, the setting is making this request for, or contributing Statutory Advice to, an EHC Needs Assessment. I confirm that the LA Educational Psychology Service is aware of this request and has been involved in supporting the setting to meet this needs. child’s/young person’s I have enclosed evidence of Consultations, Records of Involvement from relevant professionals and have gained parental consent to share these along with evidence of graduated response. Name (BLOCK CAPITALS): Signature: Date: Headteacher/ Manager / Principal: 8b Parent(s)/carer(s) I consent to this information being used as a request for, or a contribution to, an EHC Needs Assessment. If the request is agreed, I consent to appropriate agencies including Education Services, the Health Service and Social Care, sharing and discussing relevant information relating to my child. I confirm that I consent to psychological and medical reports being obtained for my child if the process goes ahead. Data Protection At 1998 The Data Controller for Bournemouth Borough Council is Head of IT Services. This information is being collected for the purpose of administering referrals, but may be used for the wider purpose(s) of the provision of education services. When you complete this document, you are providing your consent for the Council to hold and use this personal information for these purposes. The information you provide may be disclosed to: other internal directorates, those with parental responsibility, healthcare, education establishments, other LAs, the DCSF, the diocesan boards, courts and tribunals. Name(s) (BLOCK CAPITALS) and relationship to child/young Signature: Date: person: Young Person Parent(s)/Carer(s) This form was developed using a Pan Dorset approach. Information provided may be processed electronically and used for administrative, audit and quality assurance purposes. 9 Sending this form 9a How and where to send this form Please send your fully completed form and attachments as follows:
8 – Authorisations 8a Headteacher/Manager/Principal I confirm that, having followed the procedures outlined in the Code of Practice, the setting is making this request for, or contributing Statutory Advice to, an EHC Needs Assessment. I confirm that the LA Educational Psychology Service is aware of this request and has been involved in supporting the setting to meet this child’s/young person’s needs. I have enclosed evidence of Consultations, Records of Involvement from relevant professionals and have gained parental consent to share these along with evidence of graduated response. Headteacher/ Manager / Principal: Name (BLOCK CAPITALS): Signature: Date: 8b Parent(s)/carer(s) I consent to this information being used as a request for, or a contribution to, an EHC Needs Assessment. If the request is agreed, I consent to appropriate agencies including Education Services, the Health Service and Social Care, sharing and discussing relevant information relating to my child. I confirm that I consent to psychological and medical reports being obtained for my child if the process goes ahead. Data Protection At 1998 The Data Controller for Bournemouth Borough Council is Head of IT Services. This information is being collected for the purpose of administering referrals, but may be used for the wider purpose(s) of the provision of education services. When you complete this document, you are providing your consent for the Council to hold and use this personal information for these purposes. The information you provide may be disclosed to: other internal directorates, those with parental responsibility, healthcare, education establishments, other LAs, the DCSF, the diocesan boards, courts and tribunals. Name(s) (BLOCK CAPITALS) and relationship to child/young person: Signature: Date: Young Person Parent(s)/Carer(s) This form was developed using a Pan Dorset approach. Information provided may be processed electronically and used for administrative, audit and quality assurance purposes. 9 Sending this form 9a How and where to send this form Please send your fully completed form and attachments as follows:
post-16-request-for-ehc-needs-ass-form-working-draft-nov-17.docx