REPORT completed by: Role: Date: Signature: Email: Phone no: In consultation with: Name and organisation Role/relationship to learner Contact details Education Current school or other learning provision Year group Admission date Details of previous schools/learning provision (if applicable) Contact details Special Educational Needs and Disabilities (SEND) Describe the nature of the young person’s SEND and the impact this has on learning. Sources of evidence Personal qualities Please describe the young person’s holistic qualities and strengths as others see them Describe how the young person learns best Education, Training and Employment: This should be completed for all young people. It may not be possible to complete some sections in Year 9, e.g. on experiences of work. Complete these in subsequent years, in accordance with the experiences of the individual young person. Current educational provision: List any qualifications/accreditation that the young person has already achieved:
Tick () the course level the young person is studying and the predicted outcome. Working primarily to: Entry 1 Entry 2 Entry 3 Level 1 Level 2 Level 3 (A levels) Level 4 (degree) Other Predicted Outcome: Foundation Learning Award Foundation Learning Certificate Foundation Learning Diploma GCSEs Apprenticeship Other Diploma (please specify) Non-accredited achievement (please specify) Other (please specify) Give a brief description of the course/curriculum List any planned outcomes not included above – including those relating to independence and daily living skills, work experience and (supported) employment? Does the young person require any special examination arrangements? If yes, please describe What are the young person’s strengths and skills in an educational setting? What are his/her support needs in an educational setting? How they are being met? Please indicate needs such as support between classes, note takers, group sizes, adaptation of materials, specialist teachers. Wherever possible please indicate the level of support required. What assistive technology, adaptations or specialist equipment does the young person use to access education? What help does he/she require to use the technology/equipment? Work experience: What experiences of work, including school based work experience, work related activities and part-time jobs, has the young person had? What does the young person feel his/her strengths are in a work related setting? What are the young person’s strengths and skills in a work related setting from the employer’s perspective?
What support is provided in school to meet needs relating to social skills, relationship and behaviour? Who provides this support? What support is provided out of school to meet needs relating to social skills, relationship and behaviour? Who provides this support? Faith, ethnicity and cultural considerations Does the young person have any faith, ethnicity or cultural needs that should be taken into account when planning the next placement? If yes, please describe. N.B. Please do not simply name the faith. When this appendix has been completed, it should be returned to the Youth Connexions Personal Adviser APPENDIX 4: HEALTH : The school nurse is responsible for completing this section, in consultation with the young person, parent(s) and/or carer(s), other relevant health professionals, school staff and social worker (where there is one). MEDICAL REPORTS completed by: Role: Signature: Date: Agency: Email: Phone no: In consultation with: Name and organisation Role/relationship to young person Contact details Please attach details of procedures for medical support, eg administration of medication, and any relevant care plans. Support needs Room to take medication - Is this required? If yes, what is provided in school? Yes/No Rest periods and dedicated room - Are these required? If yes, what is provided in school? Yes/No