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Please fill in the
questions below to the best of your ability as this will enable us to
deal with your enquiry more effectively and efficiently. We may need to
ask you for further information and will contact you if this is the
case.
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| Your full name: |
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| Spouse/Partners name, if
applicable: |
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| Address and Postcode: |
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| Telephone: |
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| Email: |
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| May we contact you by e-mail? |
yes
no
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| Your child's full name: |
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| Child's DOB: |
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- (dd/mm/yyyy)
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| The special educational needs
of child? (e.g. Dyslexia, Speech and Language, etc.) |
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| Is the child Statemented? |
yes
no
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| If yes above, what is the
date of Statement? |
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- (dd/mm/yyyy)
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| OR, have you or the school asked the LEA to
assess your child? |
yes
no
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| If yes above, please give
details: |
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| Are there currently any
reports? |
yes
no
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| If yes above, the name and
type of expert (e.g. SALT, etc.) and date of
report or assessment: |
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| Relevant Local Education
Authority: |
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| Are there any urgent
deadlines that we need to be made aware of? (have you recently been
issued with a
Final Statement or have the LEA wrote to you to say that they are not
going to assess your
child?). Please include dates: |
yes
no
If yes, please enter dates
below:
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| Your preferred choice of
school? |
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| Briefly state your objectives
(what you want to achieve) and general outline of case: |
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| Do you work? What do you (and
your spouse/partner, if applicable) do? |
yes
no
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| Do you or your child receive
any state benefits? |
yes
no |
| If yes above, please give
details: |
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| Best time to avoid contacting
you? |
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| Recommended by: |
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| Subject: |
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| Please include any additional
information that you believe may be helpful: |
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Someone will contact
you from the Education Department after we have received this completed
form. We will ask you to send in paperwork (including reports)
and will make further contact after having read through the papers. |
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