Request an EHC needs assessment

Before starting, we recommend reading the form on this page and collating all of the relevant information that you have.

To protect your sensitive information, it's not possible to part complete your request and send it to us at a later time. However, there will be opportunity to add more information and upload documents after we receive your request.

Information sharing & data protection Statement

We will use the information in this form to consider whether to conduct a needs assessment under the requirements of the Children & Families Act 2014.

We may also share relevant information on a confidential basis with the Department for Education and Local Government, other Government agencies and other public bodies involved with the implementation of the new legislation as required to meet our statutory obligations.

The information that you and other professionals provide will normally be shared with your consent. Examples of situations when we may share information without your consent are:

If we need to find out urgently if a child is at risk of harm or we need to help a child who is at risk of harm.
If we need to help an adult who is at risk of harm.
If we need to help prevent or detect a serious crime.

* Please select one of the following

Consent
If there is any individual or organisation who you would not wish information to be shared with, please give details below and a reason why:

By ticking this box I agree to the gathering and sharing of information between my educational setting, health services, social care or other professionals as necessary to support the EHC needs assessment and planning process.

* Has the request come from the young person? (over 16 years)

Yes

Clear Selection

Preferred spoken language

Preferred written language

Address:

Is this the first request made for the child or young person?

Yes

Not known

Clear Selection

* First name

* Last name

Middle name(s)

Preferred name

UPN

A UPN consists of 1 letter, 11 numbers and 1 number or letter.

ULN

Internal system reference

* Date of birth

Age in years

Year Group Not applicable

Year Group Offset

A value of 0 means the child or young person is in their age expected year group.

* Gender

NHS Number

Legal status

Ethnicity

Preferred spoken language

Preferred written language

Main telephone

Email address

Address:

Preferred method of contact

Post

Full name

Relationship or role

Organisation (if applicable)

Preferred language

Telephone

Address:

Has parental responsibility

Yes

Clear Selection

Preferred method of contact

Post

Choose a setting or setting type for a setting?

Setting

Type

Search for a setting within the area

Request an EHC needs assessment

Information sharing and data protection statement

Information sharing & data protection Statement

1. Details of person requesting an EHCP Assessment

2. Child or young person's details

3. Child or young person's main contacts (family and involved professionals)

4. Details of the child or young person's current education setting(s)