Initial Assessment

• ALS INITIAL ASSESSMENT

• Year

  Select 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20

  • 2013/14
  • 2014/15
  • 2015/16
  • 2016/17
  • 2017/18
  • 2018/19
  • 2019/20

• Conducted on

  Date

• Personnel

  Select Noreen Dixon Richard Greenwood Diane Hill Jane Hilton Jan Barker Kai Stengel Lesley Martin Melanie Cartwright David Firth Liz Serdiville Pat Jenkinson Christiane Cartwright Other

  • Noreen Dixon
  • Richard Greenwood
  • Diane Hill
  • Jane Hilton
  • Jan Barker
  • Kai Stengel
  • Lesley Martin
  • Melanie Cartwright
  • David Firth
  • Liz Serdiville
  • Pat Jenkinson
  • Christiane Cartwright
  • Other

• If other please state who

• Assessment completed

  Face to Face

  Telephone follow up

  SEN Review

  College Open Day / Evening

  School Parents Evening

• Document No.

• Surname

• Forename

• Date of Birth

  Date

• Age at start of course

• Picture of Student

  Media

• Person code

• Contact Number

• Mobile phone number

• Emergency Contact Details

• Address

• Postcode

• LEA:

  Lancashire

  Other

• If other please enter which LEA

• Previous School

• Banding

  Select A B C D E F G H I No Banding

  • A
  • B
  • C
  • D
  • E
  • F
  • G
  • H
  • I
  • No Banding

Course/Funding Information

• Course Name

• School Code

  Select BBM - Business & Management BCE - Communication & ESOL BSC - Education, A-Level & Faith School BEA - Skills Development & Community Learning PHT - Hospitality, Tourism & The Visitor Economy PVA - Visual Performing Art & Digital PHB - Hair & Beauty Therapies TMS - Scientific Industries TEN - Engineering TCO - Construction SHS - Early Years Professional & Counselling SPF - Health Professionals SSP - Sport, Exercise & Public Services

  • BBM - Business & Management
  • BCE - Communication & ESOL
  • BSC - Education, A-Level & Faith School
  • BEA - Skills Development & Community Learning
  • PHT - Hospitality, Tourism & The Visitor Economy
  • PVA - Visual Performing Art & Digital
  • PHB - Hair & Beauty Therapies
  • TMS - Scientific Industries
  • TEN - Engineering
  • TCO - Construction
  • SHS - Early Years Professional & Counselling
  • SPF - Health Professionals
  • SSP - Sport, Exercise & Public Services

• Start Date

  Date

• End Date

  Date

• Study Mode

  full time

  part time

• Personal Tutor

• Funding Choice:

  Select 10 - Community Learning 25 - 16-19 EFA (+ 16-25 with LDA) 35 - Adult Skills (inc 16-18 App) 70 - ESF 81 - SFA Other 82 - EFA Other 99 - HE (direct HE FCE) no DSA 99 - HE (UCLan & Edge Hill) no DSA 99 - HE/DSA (either or above but with DSA) 99 - ESF (non PC) 99 - FCR 99 - ADL (24+ Advanced Learning Loan)

  • 10 - Community Learning
  • 25 - 16-19 EFA (+ 16-25 with LDA)
  • 35 - Adult Skills (inc 16-18 App)
  • 70 - ESF
  • 81 - SFA Other
  • 82 - EFA Other
  • 99 - HE (direct HE FCE) no DSA
  • 99 - HE (UCLan & Edge Hill) no DSA
  • 99 - HE/DSA (either or above but with DSA)
  • 99 - ESF (non PC)
  • 99 - FCR
  • 99 - ADL (24+ Advanced Learning Loan)

• Aspirations

• Outcomes (what does the student want to do after this course e.g. Apprenticeship, employment, University?)

Support Requirements

• Support Requirements

  Select Visual Impairment D/deaf Learning Difficulty SpLD Physical Difficulties Mental Health Difficulties Emotional, Behavioural & Social Difficulties Medical Conditions Accessibility/Mobility Personal Care

  • Visual Impairment
  • D/deaf
  • Learning Difficulty
  • SpLD
  • Physical Difficulties
  • Mental Health Difficulties
  • Emotional, Behavioural & Social Difficulties
  • Medical Conditions
  • Accessibility/Mobility
  • Personal Care

• Support Requirements L15 codes

  Select 01 - Visual Impairment 02 - Hearing Impairment 03 - Disability affecting mobility 04 - Other Physical Disability 05 - Other Medical Condition (eg Epilepsy, Asthma, Diabetes) 06 - Emotional/Behavioural Difficulties 07 - Mental Health Difficulty 08 - Temporary Disability after illness (eg post viral) or accident 09 - Profound Complex Disability 10 - Asperger's Syndrome 90 - Multiple Disabilities 97 - Other

  • 01 - Visual Impairment
  • 02 - Hearing Impairment
  • 03 - Disability affecting mobility
  • 04 - Other Physical Disability
  • 05 - Other Medical Condition (eg Epilepsy, Asthma, Diabetes)
  • 06 - Emotional/Behavioural Difficulties
  • 07 - Mental Health Difficulty
  • 08 - Temporary Disability after illness (eg post viral) or accident
  • 09 - Profound Complex Disability
  • 10 - Asperger's Syndrome
  • 90 - Multiple Disabilities
  • 97 - Other

• If other please state which:

• Support Requirements L16 Codes

  Select 01 - MLD 02 - SLD 10 - Dyslexia 11 - Dyscalculia 19 - Other Specific Learning Difficulty e.g. Dyspraxia 20 - Autism Spectrum Disorder 90 - Multiple Learning Difficulties 97 - Other

  • 01 - MLD
  • 02 - SLD
  • 10 - Dyslexia
  • 11 - Dyscalculia
  • 19 - Other Specific Learning Difficulty e.g. Dyspraxia
  • 20 - Autism Spectrum Disorder
  • 90 - Multiple Learning Difficulties
  • 97 - Other

• If other please state which:

• BKSB Maths Initial Assessment Result

  Select Level 3 Level 2 Level 1 Entry Level 3 Entry Level 2 Entry Level 1 GCSE

  • Level 3
  • Level 2
  • Level 1
  • Entry Level 3
  • Entry Level 2
  • Entry Level 1
  • GCSE

• Diagnostic Result

• BKSB English Initial Assessment Result

  Select Level 3 Level 2 Level 1 Entry Level 3 Entry Level 2 Entry Level 1 GCSE

  • Level 3
  • Level 2
  • Level 1
  • Entry Level 3
  • Entry Level 2
  • Entry Level 1
  • GCSE

• Diagnostic Result

Evidence of support requirements (copy held)

• Form 8

  Copy Held

  Requested

• Free writing

  Copy Held

  Requested

• Medical Evidence

  Copy Held

  Requested

• 139a/ EHC Plan

  Copy Held

  Requested

• SEN

  Copy Held

  Requested

• All About Me

  Copy Held

  Requested

• DSA Assessment

  Copy Held

  Requested

• Needs Assessment

  Copy Held

  Requested

• Fit to study letter

  Copy Held

  Requested

• Care Plan/Risk Assessment

  Copy Held

  Requested

• Ed Psychologist Report

  Copy Held

  Requested

• CAF/TAF

  Copy Held

  Requested

• Other

  Yes

  No

• If other please state which:

History of Support

• In Class Support (which lessons? Shared Support?)

• EAA: (reader/scribe/extra time/sep room etc) - Normal way of working

• Specialist Equipment/Assistive Technology

History of Need

• What was the aim of support?

• What worked well/what might have helped you that you didn't have?

• What support do you think might help you on your current course?

• CAF/TAF

Medical Needs

• Medical Condition/Allergy/Dietary Information

• Medication (Explain that College CANNOT Administer Medication) where is it taken? How is stored?

• Support from External Agencies (Name and contact details) (Social worker Name, Tel, YPS Advisor)

• Other information including skills/strengths/hobbies/interests

Review the following

• Attendance Issue

• Reference Check

• Looked After Child

• Excluded/Suspended

• Out of Class Support

• Mentoring/Pastoral Support

• Personal Care

• Mobility

• Risk Assessment/PEEP/Care Plan

• Reduced Timetable

• Meeting and Taking to class

• Lunch and Break Support

• Accompanying to and from transport

• Transport to and from college (YPS to apply to LEA)

Pre-enrolment actions required

• Further information

• BKSB Assessments

• Familiarisation Visit

• Taster in Portfolio Area/s

• New student festival

• Enrolment Support

• Personal Care/Payments/Carer Liaison

• Portfolio Meeting

• Reason

• Other

• Please state:

Pre-enrolment assessment appointments

• Meeting / Assessment

• Please state reason for meeting::

• Appointment with:

  Select Noreen Dixon Richard Greenwood Diane Hill Jane Hilton Jan Barker Kai Stengel Lesley Martin Melanie Cartwright David Firth Liz Serdiville Pat Jenkinson Christiane Cartwright Other

  • Noreen Dixon
  • Richard Greenwood
  • Diane Hill
  • Jane Hilton
  • Jan Barker
  • Kai Stengel
  • Lesley Martin
  • Melanie Cartwright
  • David Firth
  • Liz Serdiville
  • Pat Jenkinson
  • Christiane Cartwright
  • Other

• Date & time of appointment

  Date

• Meeting / Assessment

• Please state reason for meeting::

• Appointment with:

  Select Noreen Dixon Richard Greenwood Diane Hill Jane Hilton Jan Barker Kai Stengel Lesley Martin Melanie Cartwright David Firth Liz Serdiville Pat Jenkinson Christiane Cartwright Other

  • Noreen Dixon
  • Richard Greenwood
  • Diane Hill
  • Jane Hilton
  • Jan Barker
  • Kai Stengel
  • Lesley Martin
  • Melanie Cartwright
  • David Firth
  • Liz Serdiville
  • Pat Jenkinson
  • Christiane Cartwright
  • Other

• Date & time of appointment

  Date

Tutor Adjustments

• Difficulties with processing speed

• Difficulties with reading speed

• Not confident reading out loud

• Difficulties with verbal instructions

• Difficulties with handwriting

• Handouts issues prior to lesson

• Difficulties with note taking

• Use of mobile with note taking

• Tutor to email or use MyCourse for information

• Task clarification / simplified language

• Organisational difficulties

• Concentration difficulties

• Short term memory difficulties

• Time out cards

• Reassurance/praise/encouragement

• Likes set routine

• Need for advance warning of change

• Requires visual prompt

• Tutor to be specific in instructions

• Difficulties with social communication skills

• Visual discomfort

• Overlay colour:

• Colour of pen on whiteboard:

• Other:

Support Recommendations

• LSA in Class

• CSW in class

• CSW out of class

• Educational Psychologist Assessment

• Counselling

• Tina

• Inclusion Contract

• Learning Mentor out of class

• Independence Coach

• EAA

• EAA - Medical

• Assistive Technology Assessment - ICT

• Overlay Assessment

• Materials Adaption

• Tutor Adjustments

• Risk Assessmentcompleted

• PEEP

• Evac Training

• Safe haven Training

• Medical alert to Portfolio area

• ELM Support

• Travel Training (Taxi)

• Independent Travel Training

• Vulnerable Learner

• Refer to safeguarding officer

• Achievement Tutor

• ALS Coding

  Green

  Amber

  Red

• The SEN / Learning Support Team wishes to share/release information on a 'need to know' basis so that we can provide the most appropriate support for you

Disclosure/Enrolment Statement

• Support required

  Support Not Required

  Support Declined

  Support Agreed

• Primary Needs

  Select Visual Impairment D/deaf Learning Difficulty SpLD Physical Difficulties Mental Health Difficulties Emotional, Behavioural & Social Difficulties Medical Conditions Accessibility/Mobility Personal Care

  • Visual Impairment
  • D/deaf
  • Learning Difficulty
  • SpLD
  • Physical Difficulties
  • Mental Health Difficulties
  • Emotional, Behavioural & Social Difficulties
  • Medical Conditions
  • Accessibility/Mobility
  • Personal Care

• Other (e.g. Reason behind support / declined support)

• I agree to this information being shared within college and with relevant outside bodies (e.g. Work placements, exam boards etc)

  Yes

  No

  N/A

• I understand that I may lose my allocated support sessions if I do not attend support sessions regularly and notify the SEN/ Learning Support Team of any absence

  Yes

  No

  N/A

• All requests for SEN / Learning Support will be considered on an individual basis by the SEN / Learning Support Team. Applications for support cannot be processed until all relevant evidence is received.

  Yes

  No

  N/A

• Add signature

  Sign

• Staff signature:

  Sign

Admin use

• Person to cost for:

  Select Noreen Dixon Richard Greenwood Diane Hill Jane Hilton Jan Barker Kai Stengel Lesley Martin Melanie Cartwright David Firth Liz Serdiville Pat Jenkinson Christiane Cartwright Other

  • Noreen Dixon
  • Richard Greenwood
  • Diane Hill
  • Jane Hilton
  • Jan Barker
  • Kai Stengel
  • Lesley Martin
  • Melanie Cartwright
  • David Firth
  • Liz Serdiville
  • Pat Jenkinson
  • Christiane Cartwright
  • Other

• Time taken

  Select 5 mins = 0.08 10 mins = 0.17 15 mins = 0.25 20 mins = 0.33 25 mins = 0.42 30 mins = 0.50 35 mins = 0.58 40 mins = 0.67 45 mins = 0.75 50 mins = 0.83 55 mins = 0.92 60 mins = 1.00 65 mins = 1.08 70 mins = 1.17 75 mins = 1.25 80 mins = 1.33 85 mins = 1.42 90 mins = 1.50 95 mins = 1.58 100 mins = 1.67 105 mins = 1.75 110 mins = 1.83 115 mins = 1.92 120 mins = 2.00 125 mins = 2.08 130 mins = 2.17 135 mins = 2.25 140 mins = 2.33 145 mins = 2.42 150 mins = 2.50 155 mins = 2.58 160 mins = 2.67 165 mins = 2.75 170 mins = 2.83 175 mins = 2.92 180 mins = 3.00 185 mins = 3.08 190 mins = 3.17 195 mins = 3.25 200 mins = 3.33 205 mins = 3.42 210 mins = 3.50 215 mins = 3.58 220 mins = 3.67 225 mins = 3.75 230 mins = 3.83 235 mins = 3.92 240 mins = 4.00

  • 5 mins = 0.08
  • 10 mins = 0.17
  • 15 mins = 0.25
  • 20 mins = 0.33
  • 25 mins = 0.42
  • 30 mins = 0.50
  • 35 mins = 0.58
  • 40 mins = 0.67
  • 45 mins = 0.75
  • 50 mins = 0.83
  • 55 mins = 0.92
  • 60 mins = 1.00
  • 65 mins = 1.08
  • 70 mins = 1.17
  • 75 mins = 1.25
  • 80 mins = 1.33
  • 85 mins = 1.42
  • 90 mins = 1.50
  • 95 mins = 1.58
  • 100 mins = 1.67
  • 105 mins = 1.75
  • 110 mins = 1.83
  • 115 mins = 1.92
  • 120 mins = 2.00
  • 125 mins = 2.08
  • 130 mins = 2.17
  • 135 mins = 2.25
  • 140 mins = 2.33
  • 145 mins = 2.42
  • 150 mins = 2.50
  • 155 mins = 2.58
  • 160 mins = 2.67
  • 165 mins = 2.75
  • 170 mins = 2.83
  • 175 mins = 2.92
  • 180 mins = 3.00
  • 185 mins = 3.08
  • 190 mins = 3.17
  • 195 mins = 3.25
  • 200 mins = 3.33
  • 205 mins = 3.42
  • 210 mins = 3.50
  • 215 mins = 3.58
  • 220 mins = 3.67
  • 225 mins = 3.75
  • 230 mins = 3.83
  • 235 mins = 3.92
  • 240 mins = 4.00

• Date

  Date

• Person to cost for:

  Select Noreen Dixon Richard Greenwood Diane Hill Jane Hilton Jan Barker Kai Stengel Lesley Martin Melanie Cartwright David Firth Liz Serdiville Pat Jenkinson Christiane Cartwright Other

  • Noreen Dixon
  • Richard Greenwood
  • Diane Hill
  • Jane Hilton
  • Jan Barker
  • Kai Stengel
  • Lesley Martin
  • Melanie Cartwright
  • David Firth
  • Liz Serdiville
  • Pat Jenkinson
  • Christiane Cartwright
  • Other

• Time taken

  Select 5 mins = 0.08 10 mins = 0.17 15 mins = 0.25 20 mins = 0.33 25 mins = 0.42 30 mins = 0.50 35 mins = 0.58 40 mins = 0.67 45 mins = 0.75 50 mins = 0.83 55 mins = 0.92 60 mins = 1.00 65 mins = 1.08 70 mins = 1.17 75 mins = 1.25 80 mins = 1.33 85 mins = 1.42 90 mins = 1.50 95 mins = 1.58 100 mins = 1.67 105 mins = 1.75 110 mins = 1.83 115 mins = 1.92 120 mins = 2.00 125 mins = 2.08 130 mins = 2.17 135 mins = 2.25 140 mins = 2.33 145 mins = 2.42 150 mins = 2.50 155 mins = 2.58 160 mins = 2.67 165 mins = 2.75 170 mins = 2.83 175 mins = 2.92 180 mins = 3.00 185 mins = 3.08 190 mins = 3.17 195 mins = 3.25 200 mins = 3.33 205 mins = 3.42 210 mins = 3.50 215 mins = 3.58 220 mins = 3.67 225 mins = 3.75 230 mins = 3.83 235 mins = 3.92 240 mins = 4.00

  • 5 mins = 0.08
  • 10 mins = 0.17
  • 15 mins = 0.25
  • 20 mins = 0.33
  • 25 mins = 0.42
  • 30 mins = 0.50
  • 35 mins = 0.58
  • 40 mins = 0.67
  • 45 mins = 0.75
  • 50 mins = 0.83
  • 55 mins = 0.92
  • 60 mins = 1.00
  • 65 mins = 1.08
  • 70 mins = 1.17
  • 75 mins = 1.25
  • 80 mins = 1.33
  • 85 mins = 1.42
  • 90 mins = 1.50
  • 95 mins = 1.58
  • 100 mins = 1.67
  • 105 mins = 1.75
  • 110 mins = 1.83
  • 115 mins = 1.92
  • 120 mins = 2.00
  • 125 mins = 2.08
  • 130 mins = 2.17
  • 135 mins = 2.25
  • 140 mins = 2.33
  • 145 mins = 2.42
  • 150 mins = 2.50
  • 155 mins = 2.58
  • 160 mins = 2.67
  • 165 mins = 2.75
  • 170 mins = 2.83
  • 175 mins = 2.92
  • 180 mins = 3.00
  • 185 mins = 3.08
  • 190 mins = 3.17
  • 195 mins = 3.25
  • 200 mins = 3.33
  • 205 mins = 3.42
  • 210 mins = 3.50
  • 215 mins = 3.58
  • 220 mins = 3.67
  • 225 mins = 3.75
  • 230 mins = 3.83
  • 235 mins = 3.92
  • 240 mins = 4.00

• Date

  Date

• Person to cost for:

  Select Noreen Dixon Richard Greenwood Diane Hill Jane Hilton Jan Barker Kai Stengel Lesley Martin Melanie Cartwright David Firth Liz Serdiville Pat Jenkinson Christiane Cartwright Other

  • Noreen Dixon
  • Richard Greenwood
  • Diane Hill
  • Jane Hilton
  • Jan Barker
  • Kai Stengel
  • Lesley Martin
  • Melanie Cartwright
  • David Firth
  • Liz Serdiville
  • Pat Jenkinson
  • Christiane Cartwright
  • Other

• Time taken

  Select 5 mins = 0.08 10 mins = 0.17 15 mins = 0.25 20 mins = 0.33 25 mins = 0.42 30 mins = 0.50 35 mins = 0.58 40 mins = 0.67 45 mins = 0.75 50 mins = 0.83 55 mins = 0.92 60 mins = 1.00 65 mins = 1.08 70 mins = 1.17 75 mins = 1.25 80 mins = 1.33 85 mins = 1.42 90 mins = 1.50 95 mins = 1.58 100 mins = 1.67 105 mins = 1.75 110 mins = 1.83 115 mins = 1.92 120 mins = 2.00 125 mins = 2.08 130 mins = 2.17 135 mins = 2.25 140 mins = 2.33 145 mins = 2.42 150 mins = 2.50 155 mins = 2.58 160 mins = 2.67 165 mins = 2.75 170 mins = 2.83 175 mins = 2.92 180 mins = 3.00 185 mins = 3.08 190 mins = 3.17 195 mins = 3.25 200 mins = 3.33 205 mins = 3.42 210 mins = 3.50 215 mins = 3.58 220 mins = 3.67 225 mins = 3.75 230 mins = 3.83 235 mins = 3.92 240 mins = 4.00

  • 5 mins = 0.08
  • 10 mins = 0.17
  • 15 mins = 0.25
  • 20 mins = 0.33
  • 25 mins = 0.42
  • 30 mins = 0.50
  • 35 mins = 0.58
  • 40 mins = 0.67
  • 45 mins = 0.75
  • 50 mins = 0.83
  • 55 mins = 0.92
  • 60 mins = 1.00
  • 65 mins = 1.08
  • 70 mins = 1.17
  • 75 mins = 1.25
  • 80 mins = 1.33
  • 85 mins = 1.42
  • 90 mins = 1.50
  • 95 mins = 1.58
  • 100 mins = 1.67
  • 105 mins = 1.75
  • 110 mins = 1.83
  • 115 mins = 1.92
  • 120 mins = 2.00
  • 125 mins = 2.08
  • 130 mins = 2.17
  • 135 mins = 2.25
  • 140 mins = 2.33
  • 145 mins = 2.42
  • 150 mins = 2.50
  • 155 mins = 2.58
  • 160 mins = 2.67
  • 165 mins = 2.75
  • 170 mins = 2.83
  • 175 mins = 2.92
  • 180 mins = 3.00
  • 185 mins = 3.08
  • 190 mins = 3.17
  • 195 mins = 3.25
  • 200 mins = 3.33
  • 205 mins = 3.42
  • 210 mins = 3.50
  • 215 mins = 3.58
  • 220 mins = 3.67
  • 225 mins = 3.75
  • 230 mins = 3.83
  • 235 mins = 3.92
  • 240 mins = 4.00

• Date

  Date