Request for Rowan Gate Outreach 2023/24

Referring School: *

Parent Consent *

Yes

No

Please note we require scanned copies

Referred by *

Contact email: *

SENCO email (if different from above):

Date of Referral *

Child Details

Child Name *

Year Group *

Date of Birth *

Gender Identity *

Male

Female

Other

Does the child speak English as an additional language? *

Yes

No

EAL: Language/s spoken: *

How would you describe the child's ethnic origin *

Support

SEND support provided *

Early Help Locality Funding (EHLF)

Request for Statutory Assessment (RSA)

Education Health Care Plan (EHCP)

Other SEND Support (provide details)

Other SEND Support

Professional Involvement *

Educational Psychologist

Speech and Language Therapist

Occupational Therapy

Community Paediatrician

Social Worker

Specialist Support Service

Maplefields Outreach

School Nurses

Other (provide details)

Other Professional Involvement

Current Development Levels

i.e. Current stage of development or academic year they are working within/EYFS stage of development matters. We need specific assessment information OY (Out of Year group) is not sufficient information.

Reading

Writing

Maths

PSHE

Reason for Request *

What have you tried already? *

Parent’s view

Child’s views

File Attachment Uploads

Use the panel below to upload Word or PDF evidence for Consent, Agency information, EHCP and Individual Learning/Education Plans.

Attachment Uploads *

Drag and drop files here or Browse

This information will be automatically emailed to and a copy will be sent to the email address you provided.

Request for Rowan Gate Outreach Support

Criteria for referral:

Before a request is considered it is anticipated that the referring school will:

Have made extensive efforts to engage parents/carers in supporting children’s learning and inclusion
Have some evidence of an individualised targeted and differentiated approach
Provide additional support from within the school’s own resources

Referring schools should be committed to working alongside staff from Rowan Gate Outreach Service to consider how they can develop their capacity to support pupils with difficulties with communication and interaction and/or cognition and learning

When making a referral for Rowan Gate Outreach Support:

We will acknowledge receipt of your referral within 2 working days.
A member of the Outreach Team will contact you to identify a time slot to respond to your request.

What we do:

Following a request for support the Outreach Team will contact the school to discuss next steps
We will then visit the school, meet with staff to gather additional information and carry out an observation
Once information has been gathered the Outreach Team will make recommendations based on the observation and where appropriate, provide practical support and resources
Following the initial visit/s a maintenance visit will be arranged to discuss progress and provide additional support if required

Outreach Referral (Single Child)