Information from School to support the Umbrella Pathway Process

Evidence of Graduated Response that has been considered and implemented over time

Name

Address Date of Birth:

Please provide information about his/her attainments in relation to their peer group and his/her general academic progress (e.g.
Literacy/Numeracy/Science National Curriculum Level). Do you think s/he is underachieving for their ability? Please attach any reports that are
available to indicate learning levels.

Do you have any concerns about his/her attention/listening and language skills? Please give details below and attach any speech and language
therapy reports if available.
Attention/Listening:

Receptive language skills:

Expressive language skills:

Please provide reasons for this referral (include information such as: making friendships, flexibility of thought and behaviour, play skills/creativity and strong
hobbies, social interaction and conversational style and use of non-verbal communication)

Have you used any interventions or strategies in school to address the child’s difficulties? If so please give details of which ones have been
successful/unsuccessful.

What are your views about what can be done to help this child?

Your name and designation: Date:

School Name and address: Telephone contact number:

Please give an account of strategies used in any completed "Assess, Plan, Do, Review" Cycles within the Graduated Response. Please indicate
where these have been as a result of involvement of external agency involvement.

Please attach details of intervention, targets set and whether targets were achieved.

Action taken to address SEN including in-class, What was the effect of this intervention e.g. educational
small group and individual support outcomes, learning gains

Assess, Plan,
Do, review
Cycle One

Assess, Plan,
Do, review
Cycle Two
Indicate where
external
professional
advice
implemented