Get Private And Confidential Please Do Not Fax

Filling out the PRIVATE AND CONFIDENTIAL PLEASE DO NOT FAX form is an essential step in referring a pupil who is experiencing social, emotional, and behavioral difficulties. This guide provides clear instructions to help you navigate each section of the form effortlessly.

Follow the steps to complete your referral form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Enter the name of the school in the designated field. Ensure you provide accurate information for proper identification.
3. Fill in the school email address correctly to allow for effective communication regarding the referral.
4. Input the name of the pupil, ensuring that it matches exactly as per official documents.
5. Specify the pupil's gender (M/F) to assist in demographic tracking.
6. Provide the date of birth in the required format, making sure it is accurate for record-keeping.
7. Indicate the class or year the pupil is currently in, which will help identify the educational context in which the problems arise.
8. List the names of parent(s) or guardian(s) who are responsible for the pupil to establish contact points.
9. State the number of individuals in the family, which may provide context for any additional support needed.
10. Choose the location of the pupil’s residence and fill that in as well.
11. Answer the question about whether the pupil is a looked after child by circling 'Yes' or 'No'.
12. Indicate whether the problem is of sudden onset or a longer-term issue, providing insight into the pupil's situation.
13. Describe any special circumstances that may have contributed to the current difficulties, ensuring to include relevant details.
14. List the names and positions of staff who have been consulted about the referral to demonstrate collaboration.
15. Clearly describe the difficulties the pupil is facing, including nature, frequency, and intensity using observable terms.
16. Specify if a risk assessment has been carried out by marking 'Yes' or 'No'.
17. Indicate if a risk management plan has been created and implemented by circling the appropriate response.
18. State whether the pupil has been suspended and provide details if applicable.
19. Provide the current stage of the pupil on the school’s register of Special Educational Needs, circling the correct option.
20. Detail the reason for inclusion on the SEN register and indicate any additional document attachments.
21. Identify any support structures currently in place for the pupil, highlighting what is working.
22. List any agencies currently involved with the pupil, marking their involvement status as needed.
23. Provide advice and guidance that would help staff manage the pupil’s behavior effectively.
24. Make sure the principal's signature and the date of referral are entered, along with the parent's signature and date to confirm agreement.
25. Once all fields are filled in correctly, save your changes, download or print the form as needed, and submit it to the SEBD Support Team.

Start filling out your referral form online to ensure timely support for the pupil.