Specialist Information, Advice and Guidance Referral Form

Name of referrer *

Position in school/setting *

Contact Email Address *

Please tick the box below to confirm you have the agreement from the Headteacher or Senior Leader of the School / Trust *

Name of school / MAT senior leader approving this request *

Name of school/setting (if different)

Name of SENCo (if not the referrer)

Date of request for involvement *

Describe the challenges you are facing regarding SEND provision in your setting *

What would be the desired outcome of a request for the involvement of this service? How would this be measured? *

Which support services have you used in the last year (Cornwall Council, NHS and/or independent)? *

Privacy Statement

The information you provide is being collected by the Education Service, Together for Families Directorate for the purpose of supporting your institution with your SEND & Inclusion Needs.

This information may also be shared with other professionals in conjunction with the nature of the request or enquiry. The data held relating to the delivery of area will be used for the provision of this service. This information will be held in a secure environment in accordance with the TFF data retention policy after which time it will be destroyed in a secure manner. If you wish to see what data we hold about you, or ask we rectify this data or erase the data you should contact the Education Service. A full copy of our Privacy Notice can be found at www.cornwall.gov.uk/tffprivacynotice