Information

  • Year

  • Personnel

  • Students name

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<br>(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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.