Personal/course information

Personal/course Information

  • Person Code

  • D.O.B.

  • Mobile number

  • Home number

  • Email address

  • Course Name

  • School Code

  • Start Date

  • End Date

  • Funding Choice:

  • Achievement tutor

Reason for request

Reason for request

  • Difficulty / disability

  • If other please state which:

  • Difficulty / disability (spell check, proof reading, reading out info)

  • Handwriting (Note taking, speed, legibility, tiredness, medical condition, EAA)

  • Physical Disability (ligher equipment, mobility, medical conditions)

  • Memory (info from class, reminders, note taking)

  • Method of working (handwritten, typed, previously used laptop in school, EAA)

  • Planning and organisation (lists, mind maps, no planning)

ICT

ICT

  • Computer confidence (Office, MyCourse, typing skills - multi finger, touch type, speed, back-up)

  • Overlays in use (B/G colour, font colour, font size, link colours)

Software and Equipment

Software and Equipment

  • Supernova

  • Texthelp

  • My study bar

  • Spell checker

  • Logic

  • External mouse

  • Zoomtext

  • ClaroRead

  • Dictaphone

  • Smartpen

  • Garage band

  • Backpack

  • Inspirations

  • Dragon

  • Reading pen

  • Final cut

Evidence

Evidence

  • Evidence

Additional Notes

Additional Notes

  • Additional notes

Support given

Support given

  • 1:1

  • In Class

  • Mentoring

  • Independence Coach

Tutor Adjustments

Accessing information

  • Difficulties

  • Strategies

  • Other: (please specify)

  • Overlay colour:

  • Colour of pen on whiteboard:

Producing information

  • Difficulties

  • Strategies

  • Other: (please specify)

Working memory / concentration

  • Difficulties

  • Strategies

  • Other: (please specify)

Communication/Social interaction

  • Difficulties

  • Strategies

  • Other: (please specify)

Sensory

  • Difficulties

  • Strategies

  • Other: (please specify)

Support Recommendations/Appointments

Support Recommendations

  • Independence Coach

  • EAA

  • My study bar training

  • Dragon training

  • Other training: (please specify)

  • Overlay Assessment

  • Materials Adaption

  • Tutor Adjustments

  • Risk Assessment

  • PEEP

  • Evacuation Chair Training

  • Safe Haven Training

  • Independent Travel Training

  • Vulnerable Learner

  • Achievement Tutor

Declaration

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

Disclosure/Enrolment Statement

  • Support required

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

  • 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

  • Student signature:

  • Staff signature:

Admin use

  • Person to cost for:

  • Time taken

  • Date

  • Person to cost for:

  • Time taken

  • Date

  • Person to cost for:

  • Time taken

  • Date

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