19 Parents views on their child’s additional needs. Please ensure these are completed Pupil/student views. Please ensure these are completed 20 For charged services Please tick what level of support you are requesting for the pupil – 21 Level of support Cost Tick Level 1 Core Level 2 Enhanced Consultancy ½ day For funded services Please tick what level of support you are requesting for the pupil – 22 Autumn Referral Spring Referral Summer Referral Contact 23 Member of responsible for information on this form and service request. Name Email Telephone School Date Application Submitted Direct Line Contact Role in School Privacy Notice Southampton City Council is collecting this information in order to perform this service or function, and if further information is needed in order to do so, you may be contacted using the details provided. In performing this service, the Council may be required to share your information with other organisations or departments, but it will only do so when it is necessary in order for the service to be provided. The Council may also share personal information for the purposes of the prevention, investigation, detection, or prosecution of criminal offences, but will not share personal information, or use it for this, or any other purpose, unless provided for by law. The information provided will be held on file and may also be stored electronically and will be used for the purpose of its involvement in giving support and advice in relation to the child/young person as specified above. More detailed information about the Council’s handling of your personal data can be found in its privacy policy, available online (), or on request.
19 Parents views on their child’s additional needs. Please ensure these are completed 20 Pupil/student views. Please ensure these are completed 21 For charged services – Please tick what level of support you are requesting for the pupil Level of support Cost Tick Level 1 Core Level 2 Enhanced Consultancy ½ day 22 For funded services – Please tick what level of support you are requesting for the pupil Autumn Referral Spring Referral Summer Referral 23 Contact Member of responsible for information on this form and service request. Date Application Submitted School Contact Name Email Telephone Direct Line Role in School Privacy Notice Southampton City Council is collecting this information in order to perform this service or function, and if further information is needed in order to do so, you may be contacted using the details provided. In performing this service, the Council may be required to share your information with other organisations or departments, but it will only do so when it is necessary in order for the service to be provided. The Council may also share personal information for the purposes of the prevention, investigation, detection, or prosecution of criminal offences, but will not share personal information, or use it for this, or any other purpose, unless provided for by law. The information provided will be held on file and may also be stored electronically and will be used for the purpose of its involvement in giving support and advice in relation to the child/young person as specified above. More detailed information about the Council’s handling of your personal data can be found in its privacy policy, available online (), or on request.
SAOS-Request-Form.docx