Education, health and care needs assessments and plans

Please make sure you have the following information ready for you and the person being referred, before you apply:       

• your contact details
• your school, setting or organisation details
• child or young person details (including full name, date of birth and address)
• child or young person school or setting
• child or young person information (including their Synergy number). Not providing a Synergy Number may delay the referral being processed
• parent or carer details
• professional third parties already involved
• child or young person care circumstances
• educational context (details of reduced timetable, education in an alternative provision, any suspensions or exclusions and absence details)
• educational attendance percentage
• educational performance (attainment in Early Years or English, Maths, and Science)
• child or young person strengths
• health information
• social information (provide the child or young person's care needs)
• child or young person's voice including their views, interests and aspirations
• details of outcomes

Additional needs

If any of the following needs are applicable, you need to summarise how you have supported the child or young person through the graduated approach:       

• cognition and learning needs
• communication and interaction needs
• social, emotional and mental health needs
• physical and sensory needs
• independence and self-care needs

General hints and tips

Save and resume later
The form has been arranged so you can update it in stages, we encourage you to use the 'save and resume later' feature so that your pages are always saved and you can come back to your application later.

You have 28 days to complete your application.

Save or print a copy
We recommend you save a copy of the form which you can do either before you submit the form, or after you click submit. You can do this by right clicking your mouse on the summary page and choose Print, then save as PDF.

Alternatively, you can select print from your browser options.

Other useful hints and tips:

• you can edit the form by using the back button if you do need to change any information
• text boxes have a character limit, and this is displayed under the text box
• you can attach any additional information in the evidence section at the end of the form

Declaration and consent

By ticking the boxes you will be providing your consent for any personal and sensitive information provided to be collected, used, shared and held by Leeds City Council specifically for the assessment of the child or young person.

Information we will ask you:

• some contact details including address, phone number and email address (if you have one)
• your relationship to the child or young person

Information we will need about the child or young person:

• some basic information including their name, date of birth, address details, ethnicity and language and how the child currently communicates
• if at school, we will need the name of the registered school or place of education and how long they have been at their school

Special educational needs

Medical and health needs
You will be asked if the child has any known or possible medical or health needs that have not already been covered within the information provided in the SEN section.

Care needs
You will be asked if the child has any possible or known independence or care needs that have not already been covered within the information provided in the SEN section.

What is working well and not working well
We would like to understand more about what has led you to making this application. Tell us what is working well and not working well for the child or young person at the moment.

We will also ask:

• views, interests and hopes for the child or young person
• outcomes or goals you want to achieve and support needed to achieve them
• why you feel that your child or young person needs or may need an Education, Health and Care Plan to support their SEN

Professionals you want us to contact

On the form you can provide any medical or support therapists, social workers or other professionals or agencies that have supported the child or young person.

If you decide to add the professional you will need to include an email address.

Attach any evidence that would support your request

You will be able to attach evidence of any diagnosis or other evidence from the last year to support your request. This could be medical reports, assessments, school reports and other documentation that will help support this request.

You can attach up to 10 files, each file must be less than 10MB.