Parent Sign Up Form Inquiry From Parents Your Name(Required) Email Address(Required) Phone Number(Required)What is your relationship to the child/young person?(Required) Who will be funding the sessions? Name (if different from above)(Required) Local Authority (Name of LA) Other If funded through LA please complete the following Interim support Part of EOTAS package OtherChild/Young Person’s Name:(Required) Gender: Age:(Required) School Year Group:(Required) Full Address:(Required)Does the young person attend school or college? If yes, name of school or college:(Required)If the child/young person does not attend school or college please provide details and information above:What are the diagnoses, or possible diagnoses and needs of the child/young person? ASC (Autism) Dyscalculia Anxiety Speech And Language PDA SEMH / Mental Health ADHD Executive Functioning / Study Skills Working Memory Difficulties Dyslexia Processing needs ADD Social Skills Sensory / Auditory Needs Complex Medical Needs Challenging Behaviours Other, please describe in more detail What are the child/young person’s main area of needs? Primary Maths Engagement, trust and interest in learning Primary English / Literacy Study Skills & Executive Functioning skills Secondary Maths (Including GCSEs) Social Communication & Language Skills Secondary English (Including GCSEs) Community Support and outside activities Secondary Science (including GCSEs) Developing confidence and self-esteem Functional Skills (English & Maths) Developing independence Homework Support Progress and Attainment Levels Working at age related expectations Working below age related expectations Working above age related expectations Please provide details of your child/ young person's academic levels.Please Provide details of Progress and Attainment Levels What are the hobbies and interests of the child/young person?(Required) Knowing these can help the tutor to engage the student, to develop trust and a meaningful relationship?When would you like the sessions to begin?(Required) ASAP, date, when funding is approved, etc.How would you like the sessions to be delivered?(Required) Online sessions In person sessions When would you ideally like the sessions?(Required) How many hours / sessions would you like a week?(Required) Minimum sessions times are 1 hour.Are there any behavioural needs or triggers that the tutor should be aware of?(Required) Are there any health & safety matters that the tutor should be made aware of?(Required)The Tutor will receive (60% of total cost) and SEN Tutors (40% of the total cost).(Required) Thank you, I understand Do you agree that SEN Tutors can share this completed booking form with any tutors that I wish to be introduced to. This includes all contact information and information about the child/young person.(Required) Yes, I agree Please provide any additional information you feel will help in the matching process to find the right tutor.(Required)
