Part 1: Personal Details The young person Full Name Date of birth Address GP Name GP Surgery NHS Number Looked After Nationality Child Languages Interpretation or preferred method needed of communication Mobile number Address (optional) (optional) Primary area of Secondary need area(s) of need Name of current setting or school The parents or carers Parent/Carer Parent/Carer Names Address Telephone Mobile Email address Languages or preferred method of communication Parental Yes / No Yes / No Responsibility Interpretation Yes/No Yes/No needed
Part 1: Personal Details The young person Full Name Date of birth Address GP Name GP Surgery NHS Number Nationality Looked After Child Languages or preferred method of communication Interpretation needed Mobile number (optional) Address (optional) Primary area of need Secondary area(s) of need Name of current setting or school The parents or carers Parent/Carer Parent/Carer Names Address Telephone Mobile Email address Languages or preferred method of communication Parental Responsibility Yes / No Yes / No Interpretation needed Yes/No Yes/No
SettingSchoolandCollegeEHCApplicationKS4andabove.docx