Step 1 - Register child / young person*

COMPLETE THE DETAILS FOR CHILD/YOUNG PERSON*

IMPORTANT:  Enter information in a continuous line. 

Use your cursor or TAB to the next item and do not use ENTER

Status of parent / carer 1
Status of child

Hint:  Enter information in a continuous line.  Use your cursor or TAB to the next item and do not use ENTER

Status of parent / carer 2

Please note, the SDQ form above cannot be completed online.  Scan your completed form and email it securely to: lesley.simpson-gray@protonmail.com 

Your Referral

COMPLETE THE DETAILS OF YOUR ISSUE OR CONCERN

Referrer Status:
Existing Educational Support

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Pre-existing (diagnosed) conditions

Please note, the SDQ form above cannot be completed online.  Scan your completed form and email it securely to: lesley.simpson-gray@protonmail.com 

Hint:  Enter information in a continuous line.  Use your cursor or TAB to the next item and do not use ENTER

Additional information

Upload File
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Upload additional supporting documents and your comments below

Share your comments or additional information, especially if this differs from the referral details above, eg. how does this child present in other settings