Request an education, health and care needs assessment

Use this form to submit an online request for an EHC assessment (professionals only).

  • This form will take approximately 60 minutes to complete.
  • Please allow yourself enough time to complete this form in one session as there is not an option to save and come back to it later.
  • The questions marked with an asterisk (*) are mandatory and require an answer. You do not have to answer all of the other questions, but it would help us if you do.
  • It is expected that you will complete this referral after discussing it with the family first.
  • This form must be completed with reference to Education, Health & Care Needs Assessment guidance.
  • If an EHC needs assessment is initiated this form will constitute all or part of the educational advice and will be shared with other agencies as appropriate. It is the educational setting's responsibility to obtain permission from relevant professionals when including additional evidence.

Requester details

Enter your first name.
Enter your last name.
Enter your role.
Enter organisation name.
Enter an email address where we can write to you.
Enter a daytime phone number that we can ring you on. This can be a mobile or land line number.

Child or young person details

Select 'Yes' if there is evidence of a graduated response, for example, "Assess, Plan, Do, Review" cycle.


Enter the first name of the child or young person.
Enter the last name of the child or young person.
Enter their address name or number. This could be the flat, house or building name or number.
Enter the first line of their address. This could be the street name.
Enter the second line of their address if you need to. This could be the village name.
Enter the town or city of their postal address.
Enter their postcode, with or without spaces.
Enter their date of birth using numbers following the format dd/mm/yyyy, for example 01/12/2010.
Select the gender of the child or young person.


Enter the name of the educational setting.
Enter the school year group of the child or young person.
Enter their home language.
Enter the pupil's UPN.
Select 'Yes' if the child or young person is Looked After.


The EHC assessment is a legal process and it is imperative that all parents with parental responsibility are informed about and involved in the consideration of suitability and if agreed, the process of assessment. Please ensure you complete the details of all parents with parental responsibility below. You will need to add each parent separately, even if they live at the same address.

Parent or carer details

Enter the first name of the parent, carer or person with parental responsibility.
Enter the last name of the parent, carer or person with parental responsibility.
Select 'Yes' if the parent/carer lives at the same address.


Enter an email address where we can write to the parent/carer.
Enter a daytime phone number that we can ring the parent/carer on. This can be a mobile or land line number.
Select an 'Yes' or 'No'..


Strengths and needs details

Summarise the wishes and feeling of the child/young person.
Upload supporting document.
Upload supporting document summarising the wishes and feeling of the parent/carer.
Upload a further document summarising the wishes and feeling of the parent/carer.
Upload any supporting evidence from the child, young person, or their parent.
Upload evidence of meeting notes/dates of discussions.
Upload further evidence of meeting notes/dates of discussions.
Upload document detailing how the views of the child/young person and their family been taken into account in your planning.
Upload another document detailing how the views of the child/young person and their family been taken into account in your planning.
Select 'Yes' or 'No'.


Select 'Yes' or 'No'.


Select if this is a primary or secondary need.


Upload the cognition and learning data - form 2(c).
Enter details if the curriculum data you have provided requires further explanation, such as details of the assessment tool used. Also provide details of any standardised assessments conducted.
Upload a copy of strengths and needs for cognition and learning - form 2(ci).
Enter details below.
Enter details below.
Select 'Yes' or 'No'.


Select 'Yes' or 'No'.


Supporting evidence

Upload supporting document.
Upload current ILPs (or similar) .
Upload reviewed ILPs (or similar).
Upload reviewed ILPs (or similar). Do not go further back than 6 terms.
Upload examples of learner’s work. Indicate level of assistance if relevant.
Upload examples of learner’s work. Indicate level of assistance if relevant.
Upload Individual costed provision map. Refer to guidance note 3.
Upload evidence of discussion with EP.
Upload Post-16 Pathway and planning (essential for students in Year 11 and above)
Upload PSP if available.
Upload PEP if available.
upload Early Help Assessment/Plan if available.
Upload TAC Action Plan if available.
Upload Health Care Plan if available.
Upload Independent Professional Report if available.

Involved agencies

Select the agencies involved.
















Declaration



Important information for the professional making this request:
As the person making this request you are responsible for ensuring the family are clear that this information will be sent to the SEN Assessment Team and considered by the EHC Needs Consideration Panel.

You must ensure they are comfortable with what has been recorded and are aware that the information may be shared with other relevant professionals. You must seek their consent prior to making this request and ensure they have reviewed the information you are providing and signed the consent statement below. It is expected that you will complete this referral with the family.

Important information for the parent/carer/young person:
This information will be used to consider the suitability of EHC Needs Assessment for you or your child. In order to do this we may need to share the details in this assessment request form with other organisations or services.

We are obliged to share information if there are any concerns about the safety and/or wellbeing of a child, young person and/or adult and if there are clear reasons for doing so which are in the best interests of a child, young person and/or adult.

Enter your full name to confirm you agree to the declaration and the parent/carer and child/young person are also aware of the application and agree to the above statement.
Upload the parent/carer signed declaration.

Before you submit your form check all mandatory fields have been completed. If you submit without doing this any uploaded attachments will be lost and you will have to upload again.

Submitting your form

Click the submit button only once.

Please be patient as it may take up to a minute if you have attached large files to process your form and redirect you to our confirmation page.

 

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