This form is to request school-commissioned work - please complete as fully as possible
Current Levels of attainment:
Please give child's / young person's current levels of attainment in:
In-school support currently in place:
It is important that parents / Carers understand the reasons for making the request. We can only work with the child / young person with parent / carer understanding and consent.
The Educational Psychologist / Specialist Learning Support Teacher / Clinical Psychologist may:
I agree to this request for support by the Educational Psychology and Specialist Support Service. The contents of this form have been discussed with me.
I understand that i will be notified of the date of the appointmnt, I will have the opportunity to meet the professional and that i will receive written feedback about the outcomes of the consultation / assessment / intervention.
I understand that information from the consultation / assessment may also be shared or discussed with other professional services if that is in the best interests of my child, and will be stored securely for future reference.
Where child has sufficient understanding:
Please return to Children's Services, EPSS at the email address on Page 1 and copy to the Educational Psychologist and / or Specialist Learning Support Teacher if known.
Note: To avoid delays in our response, please ensure that forms are fully completed.
Keep a signed copy for your records
Educational Psychology & Specialist Support
Level 1, Carrow House, 301 King Street, Norwich, Norfolk, NR1 2TN
01603 307 550
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