Date of meeting:

Completed by (name and designation):

What is the child/young person good at? Where do his/her strengths lie? What progress has been made?

Are there factors creating additional support needs for the child / young person? This may include factors related to health and disability, the learning environment, family circumstances and/or social and emotional issues.

Leading on from the information given above, what are the child/young person’s additional support needs?

Educational Objectives Write objectives here, i.e. what you hope the child/young person will achieve. Where preparing the form as part of the CSP process, these objectives should last for approximately the next year	Additional Support Required from (insert name of your agency/service/educational provision) to achieve each objective Include information about the nature of the support, e.g. consultation, individual input, group input; minimum and maximum frequency of support; and likely duration, e.g. block of x weeks	Persons providing the additional support

Recent Assessment Information (within last 12 months)

Dates:	Who by:	Nature of assessment (e.g. observation)

Signed ________________________________

Date __________________________________

Report attached Yes □ No □

Nature, frequency and who is responsible for the support planned over the next 12 months

Please indicate (by circling or highlighting) the nature of support that is planned over the next 12 months. For each type of support indicated, please complete the frequency, person responsible and who will support therapy. If a column is not relevant please mark N/A.

Child’s name

Nature of support	Frequency of support (over the next 12 months)	Person responsible (please indicate designation not names)	Supported by (please indicate designation not names)
Direct individual therapy	_____ block/s of therapy. Each block lasting for ____ sessions*
Direct group therapy	_____ block/s of therapy. Each block lasting for ____ sessions*
Please either indicate a Maximum (MAX) and minimum (MIN) or tick as appropriate.
Yearly	Termly	Monthly	Fortnightly	Weekly
Advice/provision of resources
Training for staff/parents
Specialised programme
IEP planning and review
Advice on how to adapt the curriculum/environment/resources
Monitor use of specialised equipment
Advice on strategies
Monitor/review progress
Liaison with other professionals/family

(*For blocks of therapy: it is presumed that the sessions will be approx 30-45minutes long and delivered weekly. Please indicate if otherwise. It is acceptable to indicate blocks/sessions over a range e.g. 1-2 blocks of therapy. Each lasting for 4-6 sessions)

Completed by: ………………………………………

Please refer to “Guidance Notes for Completing the Summary of Information Form”