SUPPORT NEEDS ASSESSMENT FORM

(SNA)
SNA 1 & 2: SCHOOL LEVEL

Surname and names of learner: DOB: 20…. / ..... / ..... (yy/mm/dd)

………………………………………………… ID No. .................................................

LURITS/CEMIS No. .....................................

Name of school: EMIS No.: .........................................

…………………………………………………..

CONFIDENTIAL
This is a confidential document that must be kept in Learner Profile
 SUPPORT NEEDS ASSESSMENT (SNA 1 & 2)
(School-Level Intervention)

Both SNA 1 and 2 must be completed at school level

A Learner Profile, SNA 1 and SNA 2 will be required when support is requested from the District-based Support Team
(DBST).

SNA 1: ASSESSMENT AND INTERVENTION BY TEACHER

 To be completed by the class teacher and/or subject teachers if the learner is taught by
more than one teacher.
 To be completed if the Learner Profile or Screening Report or teacher observation or
parent interview shows that a learner has additional support needs.
 Captures information that will be needed when support is requested from the School-
based Support Team (SBST) by the teacher concerned.

1. AREAS OFCONCERN
Describe your concern about the learner.

 Academic and Learning Difficulties

 Behavioural and Concentration Difficulties
 Social and Home Problems
 Health Issues

When did you become aware of this?

_____________________________________________________________________________

How did you become aware of this – own observation or was it reported?
 Observation of the Child
 Interview with the Parents
 Previous Teachers
 The Learner Profile
 Child’s History

How is this observation currently affecting the learner’s learning and development? Describe.

 Hampering school performance

 Difficulty functioning in the classroom
 Problems with behaviour and socialization
 Difficulty with all academic tasks
 Struggling to learn new concepts
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  Difficulty interacting with others (teachers, parents, learners)
 Problems with physical or health issues that are hampering quality of life

Complete the following table with regard to the learner’s scholastic profile (information extracted from
Learner Profile)

YEAR
GRADE
RESULT
(Pass/ More
time/
Progressed)

NUMBER OF SCHOOLS
ATTENDED

Has any disability been diagnosed by a healthcare professional? (as captured in the Medical and
Health Assessment Form [Annexure D])
If Yes, complete the following and attach reports:

Health-care Professional Date of assessment Summary of results

2. STRENGTHS AND NEEDS OF THE LEARNER

Indicate the strengths and needs of the learner by completing the sections below.

2.1 Communication:

- The learner's ability to understand what other people are saying as well as to express him/herself in a way
that other people understand – receptive and expressive language

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 Strengths Needs/At risk factors Support needed

 Good expressive  Struggling with a  Needs help to follow

vocabulary second language instructions and
 Good communication  Difficulty with understand what is
 Learns new words expressive language expected
quickly and learning new  Needs help with
 Expresses ideas well words language development
 Developing good  Struggles to follow in general
command of second instructions and has  May benefit from an
language problems with immigrant concession
multiple instructions  Needs help with
learning a second
language
2.2 Learning:
- The learner's ability to participate satisfactorily on grade level regarding subject content and assessment

Strengths Needs/At risk factors Support needed

 Is learning at grade  There seems to be a  Needs help to keep up

level scholastic delay with the demands of
 Ready to advance in  The child is the grade
many aspects struggling to keep up  Daily support is
with the level of the provided to assist the
work learner in attaining
 There are gaps in new skills at the grade
the child’s scholastic level
skills

2.3 Behaviour and social competence:

- The learner's ability to interact and work with other learners, as well as follow classroom routines

Strengths Needs/At risk factors Support needed

 The learner is well  The learner struggles to  1 on 1 negotiation

behaved regulate his/her behaviour  Parenting skills
 The learner is eager  There are outbursts and  Counselling
to learn difficulties with impulsivity  Medication
 The learner is  There are anger issues consultation
showing good which are causing bouts of  Behaviour
interaction and destructive/violent/inappropr management skills
communication with iate behaviour  Anger management
others  There is inappropriate  Relaxation
 The learner is polite behaviour evident techniques
and helpful  Self-regulation
strategies
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2.4 Health, wellness and personal care:
- The learner's physical appearance (looking healthy, clean, well-fed), emotional well-being and
health status (consult School Health Screening Report/Road to Health Card)

Strengths Needs/At risk factors Support needed

 Healthy learner who  Sickly child  Referral to the clinic

rarely gets sick  Undernourished  Referral to school
 Well-nourished and  Not all health needs doctor
cared for attended to  Parent education
 All medical needs  Often dirty,  Referral for
attended to sometimes smells hearing/vision
 Aware and attentive of assessment
personal hygiene

2.5 Classroom and school:

- Factors within the classroom and school environment (policies, ethos, attitudes, skills,
resources, safety, etc.) that are impacting on the learner's effective participation in the learning
process and programmes offered at the school

Strengths Needs/At risk factors Support needed

 Good participation in  Struggles to  Provision of more

class activities participate practical
 Eager and excited to  Not interested in opportunities
learn school and learning  Adapted levels of
 Positive attitude to  Struggles to retain work need to be
learning and school concepts provided
 Negative attitude  Teaching methods
towards learning need to be
 Often absent examined
 Absenteeism to be
investigated

2.6 Family, home and community situation:

- Factors that may be impacting on the learner’s ability to achieve satisfactorily at school (e.g., family
structure, family stability, biological parents, siblings, other significant adults, orphan, child-headed
household, number of schools attended, homeless, in foster care, refugee, immigrant, substance abuse,
domestic violence, divorce, neglect, disabled/ill parents, poverty-stricken home background)

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 Strengths Needs/At risk factors Support needed

 Supportive family  Violence in the community is an  Social worker

environment issue intervention for the
 Gets daily help  Significant problems with learner
with homework at poverty  Counselling for the
home  Problems with relationships at learner/parents/
 Emotional needs home family
are attended to  Problems with caregiver  Parenting skills
arrangements/relations guidance
 General family/domestic  Poverty alleviation
problems that are affecting the (handouts)
child
 Parent does not attend parent
meetings or seem to take any
interest

3 TEACHER INTERVENTIONS/SUPPORT
3.1 Curriculum Intervention:
What curriculum interventions have you as teacher implemented to address your concerns?

3.1.1 Comment on/explain how the curriculum content has been differentiated, e.g., taking into
account that every learner should have access to the grade level teaching and assessment best suited
to his/her needs. Have the learner’s needs been met by a differentiated curriculum? Have the learner’s
abilities determined what is expected of him/her without discrimination? Etc.

Successes Challenges

 Given practical examples  Difficult to manage in a big class

 Worked well in a small group
 Worked well one on one
 Given multiple opportunities to
learn a concept using a variety of
resources and methods
 Provided a concession during
teaching
 Admin load is very heavy to provide level
appropriate work
 Procurement of resources is challenging
 Teacher struggles to adapt across
curriculum levels
 It is difficult to be creative
 There is not enough time

3.1.2 Comment on how teaching methods have been adapted/differentiated, e.g., how classroom
management has been changed to accommodate learners working at different levels of knowledge;
how activities have been modified to ensure that they are meaningful; how a range of graded materials
has been used (how material has been modified to allow for a learner’s disability, for instance); how the
presentation has been modified (e.g., by using pictures/pictures with descriptions/explanations, etc.)

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 Successes Challenges

 Set up of the class is conducive  Difficult to manage in a big class

for teaching learners at a range
of levels
 Pictures are used for visual
stimulation
 A range of learning styles has
been considered in choice of
resources and methods used
 Written activities are adapted
according to the level of the
learners
 Admin load is very heavy to provide
level appropriate work
 Procurement of resources is
challenging
 Teacher struggles to adapt across
curriculum levels
 It is difficult to be creative with
CAPS as it is inflexible
 There is not enough time to prepare
for so many learners in my class.

3.1.3 Comment on how the assessment has been modified, e.g., by organizing the learner’s tasks,
using different methods of assessment, without compromising the curriculum standards.

Successes Challenges

 The assessment has been given  Difficult to manage in a big class

in smaller and more manageable
chunks
 The assessment has been given
in smaller groups or one on one
 The assessment print has been
modified to be made bigger
 The assessment has been
organized differently to suit the
learner
 A range of different
assessments has been used to
get a true reflection of the
learner’s potential or
understanding
 Admin load is very heavy to provide
level appropriate assessment to
learners
 Procurement of resources is
challenging
 Teacher struggles to think of ways
to adapt the assessment according
to the learner’s needs
 It is difficult to be flexible with the
CAPS
 There is not enough time to plan for
all the different levels

3.2 What interventions have you as a teacher implemented in the learning environment
(classroom/school) to address your observations and concerns about the learner?

Comment, for example, on how the following have been modified: classroom management (e.g.,
culture/class rules/attitudes/awareness of disabilities); playground management, e.g., buddy system.
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 Successes Challenges

 The homework programme is  Teacher struggles to find ways to

working well
 Other programmes/interventions the
teacher has put in place are working
 There are NGOs and programmes
that are working well in school
 There is support from
colleagues/management/the district
office staff/private organizations
 The SBST has been helpful to refer
my learners
 Other private organizations have
been helpful
help the learners
 Teacher feels unsupported
 There are other issues impacting on
support given to the learners
(political/cultural/racial)
 There is a problem with lack of
space and resources
 Teacher feels underqualified/not
equipped to deal with the barriers
learners experience

3.3 Comment on how the physical environment has been modified/adapted E.g., the seating
arrangement of the learner has been changed to limit distractions, use of flexible grouping(s) to
accommodate learner, the environment has been made wheelchair-friendly.

Successes Challenges

 The arrangement of the desks/seating in  There is a lack of space in the class

the class is working well  There is not enough space
 Teacher has strategically placed the  There are many learners in the
learners who need support and this helps class, which makes seating
them arrangement difficult
 The learners have been grouped  The school is not wheelchair
successfully according to their needs friendly
 The school is wheelchair friendly

3.4 Any additional comments that you want to make about the barrier(s) to learning experienced
by the learner, the support/interventions provided and continuing challenges that are
experienced.

Successes Challenges

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3.5 What additional support/intervention do you as a teacher require from the School-based
Support Team (skills, resources, knowledge about curriculum differentiation (both in teaching
and assessing)?

3.6 Schedule/Log of consultation(s) with: Parent/Legal Guardian/Caregiver/Learner himself or

herself.
Date Purpose Outcome

3.7 Views expressed by Parent/Legal Guardian/Caregiver/Learner during the consultation(s):

Role player Initials and surname of person (print) Signature Date

Teacher/ 20… / … / …
Manager
Parent/Legal
20… / … / …
Caregiver
Learner (if
20… / … / …
applicable)

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SNA 2: ASSESSMENT AND INTERVENTION BY SCHOOL-BASED
SCHOOL
SUPPORT TEAM (SBST)

 th teacher
To be completed by the SBST in consultation with the
 fro the DBST by the school
To be completed when requesting support from

1. REVIEW
SBST reviews the information provided by the teacher: Section 1, supporting documents, verbal
reporting.
1.1 Does the SBST agree with the teacher’s identification of the learner’s barrier(s) to learning,
strengths and needs/challenges?
llenges? If not, provide comments:
YES NO Comments:

1.2 Does the SBST agree with the teacher’s support to deal with the barrier(s) to learning? If
not, provide comments or suggest alternative support:
YES NO Comments:

2. SUMMARY OF IDENTIFIED BARRIERS TO LEARNING AND

SUPPORT THAT WAS/IS/WILL BE PROVIDED BY SBST

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3. INDIVIDUAL SUPPORT PLAN (COMPLETED BY CLASS TEACHER AND SBST)
List the area(s) in which the support needs to be provided: Communication; Learning; Behaviour and social competence; Health, Wellness and
personal care; Classroom and school; Family, home and community; Teacher development/training, etc. (See SNA1)
Area(s) in Target to Strategy of Responsible Time frame Review date
Comment on progress
which be intervention person (to assess
made in achieving
support is achieved (If the learner needs concessions, or is an immigrant who needs achievement of
exemptions, use Annexure B
If a medical condition must be investigated by a medical or other target(s)
needed the target)
specialist, use Annexure D)
E.g. Behaviour  Assign a mentor teacher to support learner
Stop bullying
and social  Raise awareness during assembly Principal Within a week 15 April 20…
behaviour  Review school conduct policy
competence  Call in the parent/legal caregivers
 FORM DBE 120

REQUEST FOR SUPPORT FROM THE DISTRICT-BASED SUPPORT TEAM (DBST),

BY SBST
 To be completed by the SBST only when requesting support from the DBST 
 Copies of Learner Profile, SNA 1 and 2 and all other relevant supporting documents must be submitted. 

Provide reasons and motivation why support is needed from the DBST:

State what support is needed from the DBST:

Initials and surname of SBST Coordinator (print) Signature Date:

20… / … / …

PARENT/LEGAL CAREGIVER SUPPORTS REQUEST FOR DBST ASSISTANCE Yes No

Comment:

Initials and surname of parent/legal caregiver (print) Signature Date:

20… / … / …

PRINCIPAL’S PROFESSIONAL JUDGEMENT ON REQUEST FOR SUPPORT FROM DBST

Request supported Yes No

Reason for decision and recommendation

Initials and surname of principal (print) Signature Date:

20… / … / …

* Attach this form in front of the SNA 1&2 booklet when submitting to the DBST