SEND | Bilton Grange

Full Name *

First

Last

Date of Birth

Gender

Please indicate if your child has identified needs or SEN in any of the following areas.

Dyslexia

Yes
No

Please provide further details:

Dyspraxia

Yes
No

Please provide further details:

Autism Specturm Disorders (ASD) including Asperger's syndrome

Yes
No

Please provide further details:

Fine Motor Skills Disability

Yes
No

Please provide further details:

Physical Disability

Yes
No

Please provide further details:

Speech and Language Needs

Yes
No

Please provide further details:

Dyscalculia

Yes
No

Please provide further details:

Dysgraphia

Yes
No

Please provide further details:

Sensory Impairment (Visual or Hearing)

Yes
No

Please provide further details:

Tourette's Syndrome

Yes
No

Please provide further details:

ADHD

Yes
No

Please provide further details:

Is an English Language Learner (EAL)

Yes
No

Please provide further details:

SEMH (Social, Emotional and Mental Health)

Yes
No

Please provide further details:

Other

Yes
No

Please provide further details:

Does your child have an EHCP?

Please provide the name of the person at their school who coordinates their support/you have worked with?

If your child has been assessed by a specialist, please give details and please attach a copy of any reports you may have: (for example, Form 8, educational psychologist, child psychologist, Speech and Language Therapist, specialist dyslexia tutor, etc)

Does your child have any support outside school?

The following documents would be very useful in order to support your application to Bilton Grange and to give a fuller picture of your child’s needs. You may have some of these. Please attach a copy of any that you do have. (Other supporting documents may also be very helpful, if not on the list) ✓ Annual review meeting ✓ Specialist assessment ✓ Educational Psychologist’s report ✓ Child Psychologist or paediatrician’s letter ✓ Most recent school report ✓ Learning Support or SEN teacher’s report

Do you give permission for us to contact the support teacher you have named at your child’s current school?

Yes
No

Name of School

Name of Teacher

Contact Email *

Any documents copied to us will be used only for the purposes of this application and will be confidential.