My Plan
Plan Start date: Click here to enter a date.

Enter Child’s Name

Select - if plan is being completed for an Immediate Request for Statutory Assessment ☐

One Page Profile/Child’s View

What and who is important to me:
Click here to enter text.
Things I like doing:
Click here to enter text.
How you can help and communicate with me:
Click here to enter text.
My hopes and dreams:
Click here to enter text.

Consent to Share Information

Parental/Young Person Consent

As part of the My Plan for (child’s name)…………………………………. , I understand that the process includes the collection of educational, health and social care advice and reports, where relevant.

I agree to professional reports submitted as part of the My Plan process for (child’s name) ………………………………..………………………………………. being shared, if necessary with other professionals involved in order to support this process.

I understand that the personal information gathered will only be used by professionals from Sheffield City Council and other agencies to help make decisions and provide appropriate services to the above child.

I understand that Sheffield City Council and other professionals will share the minimum necessary information between people and organisations providing services that the above child is using, or is likely to use.

Name (please print)	Signature	Date
Parent
Child/Young Person (where applicable)

If there is any information or advice that the School or Local Authority may gather during the My Plan process that you wish to remain confidential, please give details below or contact the SEND team at the address given.

SEND 0-25 Team,

Level 5 North Wing,

Moorfoot,

Sheffield S1 4PL.

Tel: 0114 273 6394.

Email: ed-supportteam@sheffield.gov.uk

Table of Contents

One Page Profile/Child’s View	2

Consent to Share Information	3

1. Personal Details	5

2. Significant People – Parental Responsibility	5

2a. Significant People – Who else is important to the child	6

3. Details of Educational Setting	7

4. Professionals Providing Support	7

5. History and Background	9

6. Parent’s View	10

7. Moving On (progression, transition)	11

8. Special Educational Needs and Strengths	12

9. Care and Social Care	15

10. Health Needs and Strengths	15

11. Any Reports/Attachments from professionals, setting etc	16

12. Outcomes (in SMART format)	17

13. Special Educational Support	18

14. Agreement – Date:	19

15. Reviews	20

16. Closure and Sharing	21

1. Personal Details
First Name:	Click here to enter text.	Middle name:	Click here to enter text.
Family Name:	Click here to enter text.	Date of Birth:	Click here to enter a date.
I like to be known as:	Click here to enter text.	Looked after child?	☐
Home Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Gender:	Choose the gender.	UPN:	Click here to enter text.
NHS Number (if relevant):	Click here to enter text.	Languages Spoken:	Click here to enter text.

2. Significant People – Parental Responsibility
Relationship to child:	Choose a relationship
First Name:	Click here to enter text.	Family Name:	Click here to enter text.
Home Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Email address:	Click here to enter text.	Language Support Requirements:	Click here to enter text.

Relationship to child:	Choose a relationship
First Name:	Click here to enter text.	Family Name:	Click here to enter text.
Home Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Email address:	Click here to enter text.	Language Support Requirements:	Click here to enter text.

2a. Significant People – Who else is important to the child
Relationship to child:	Click here to enter text.
First Name:	Click here to enter text.	Family Name:	Click here to enter text.
Home Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Email address:	Click here to enter text.	Language Support Requirements:	Click here to enter text.

Relationship to child:	Click here to enter text.
First Name:	Click here to enter text.	Family Name:	Click here to enter text.
Home Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Email address:	Click here to enter text.	Language Support Requirements:	Click here to enter text.

Relationship to child:	Click here to enter text.
First Name:	Click here to enter text.	Family Name:	Click here to enter text.
Home Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Email address:	Click here to enter text.	Language Support Requirements:	Click here to enter text.

3. Details of Educational Setting
Name of setting:	Select School	Date of admission:	Click here to enter a date.
Address:	No School selected	National Curriculum Year:	Choose a year group.
Details of previous setting:	Click here to enter text.

4. Professionals Providing Support
Job Title:	Click here to enter text.	Name:	Click here to enter text.
Contact Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Type of Support Provided	Click here to enter text.

Job Title:	Click here to enter text.	Name:	Click here to enter text.
Contact Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Type of Support Provided	Click here to enter text.

Job Title:	Click here to enter text.	Name:	Click here to enter text.
Contact Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Type of Support Provided	Click here to enter text.

Professionals Providing Support - continued
Job Title:	Click here to enter text.	Name:	Click here to enter text.
Contact Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Type of Support Provided	Click here to enter text.

Job Title:	Click here to enter text.	Name:	Click here to enter text.
Contact Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Type of Support Provided	Click here to enter text.

Job Title:	Click here to enter text.	Name:	Click here to enter text.
Contact Address:	Click here to enter text.	Postcode:	Click here to enter text.
Contact Phone Number:	Click here to enter text.
Type of Support Provided	Click here to enter text.

5. History and Background
Child’s History and Background (include current educational levels and progress)	Click here to enter text.
What impact does the child's SEND have on the family?	Click here to enter text.
Does family life have any impact on the child's learning?	Click here to enter text.

6. Parent’s View
Was the child’s view section completed independently?	Yes	☐	No	☐
If not who helped:	Click here to enter text.
Important information you need to know about our child:	Click here to enter text.
What our child is good at:	Click here to enter text.
What our child needs help with	Click here to enter text.
How you can best support and communicate with our child	Click here to enter text.
Our hopes and dreams for our child’s future	Click here to enter text.

7. Moving On (progression, transition)
Is the child approaching a progression point?	Yes	☐	No	☐
Which progression point?	Click here to enter text.
What concerns does the child or parent have regarding progression?	Click here to enter text.
Who else do we need to involve in our discussion regarding progression?	Click here to enter text.

Record outcomes and support relevant to progression in Sections 12 and 13

8. Special Educational Needs and Strengths
Communication and Interaction:	Yes	☐	No	☐
What the child is good at:	Click here to enter text.
What the child needs help with:	Click here to enter text.
Any confirmed diagnoses:	Click here to enter text.
Sheffield Support Grid Category:	1A Communication and Interaction - Speech and Language	Y☐	Grid Level:	Choose an item.
1B Communication and Interaction - Social Communication	Y☐	Grid Level:	Choose an item.

Cognition and Learning:	Yes	☐	No	☐
What the child is good at:	Click here to enter text.
What the child needs help with:	Click here to enter text.
Any confirmed diagnoses:	Click here to enter text.
Sheffield Support Grid Category:	2A Cognition and Learning - Learning	Y☐	Grid Level:	Choose an item.
2B Cognition and Learning - Specific Learning Difficulties	Y☐	Grid Level:	Choose an item.

Social, Emotional, and Mental Health:	Yes	☐	No	☐
What the child is good at:	Click here to enter text.
What the child needs help with:	Click here to enter text.
Any confirmed diagnoses:	Click here to enter text.
Sheffield Support Grid Category:	3A Social Emotional and Mental Health - Emotional Regulation	Y☐	Grid Level:	Choose an item.
3B Social Emotional and Mental Health - Mental Health	Y☐	Grid Level:	Choose an item.

Hearing, Vision and Physical	Yes	☐	No	☐
What the child is good at:	Click here to enter text.
What the child needs help with:	Click here to enter text.
Any confirmed diagnoses:	Click here to enter text.
Sheffield Support Grid Category:	4A Sensory and/or Physical Needs - Visual Impairment	Y☐	Grid Level:	Choose an item.
4B - Sensory and/or Physical Needs - Hearing Impairment	Y☐	Grid Level:	Choose an item.
4C Sensory and/or Physical Needs - Physical	Y☐	Grid Level:	Choose an item.
4D Sensory and/or Physical Needs - Medical	Y☐	Grid Level:	Choose an item.

Developing Independence	Yes	☐	No	☐
What the child is good at:	Click here to enter text.
What the child needs Help with:	Click here to enter text.

9. Care and Social Care
Does the child have any identified social care needs related to their SEN?	Yes	☐	No	☐
Is a Child Protection Plan in place?	Yes	☐	No	☐
Is a Child in Need Plan in place?	Yes	☐	No	☐
Is an FCAF in place?	Yes	☐	No	☐
Is a MAST Action plan in place?	Yes	☐	No	☐
What the child needs help with?	Click here to enter text.
What is in place to support this?	Click here to enter text.
What else needs to be in place to support this?	Click here to enter text.
CareFirst ID if relevant	Click here to enter text.

10. Health Needs and Strengths
Does the child have any identified health needs related to their SEN?	Yes	☐	No	☐
Is a Health Care Plan in place?	Yes	☐	No	☐
What the child needs help with?	Click here to enter text.
What is in place to support this?	Click here to enter text.
What else needs to be in place to support this?	Click here to enter text.

11. Any Reports/Attachments from professionals, setting etc
Name of Report	From:	Date:
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.
Click here to enter text.	Click here to enter text.	Click here to enter a date.

12. Outcomes (in SMART format)
No.	Outcomes. The child will be able to…	By When?	Steps towards meeting the outcome	Progress Reviewed	Date achieved
Enter Number	Click here to enter text.	Click here to enter a date.	Click here to enter text.	Click here to enter text.	Click here to enter a date.
Enter Number	Click here to enter text.	Click here to enter a date.	Click here to enter text.	Click here to enter text.	Click here to enter a date.
Enter Number	Click here to enter text.	Click here to enter a date.	Click here to enter text.	Click here to enter text.	Click here to enter a date.
Enter Number	Click here to enter text.	Click here to enter a date.	Click here to enter text.	Click here to enter text.	Click here to enter a date.
Enter Number	Click here to enter text.	Click here to enter a date.	Click here to enter text.	Click here to enter text.	Click here to enter a date.

13. Special Educational Support
Linked Outcome No.	What is the support and who will implement it?	Timescales/ Frequency
Enter Number	Click here to enter text.	Click here to enter text.
Enter Number	Click here to enter text.	Click here to enter text.
Enter Number	Click here to enter text.	Click here to enter text.
Enter Number	Click here to enter text.	Click here to enter text.
Enter Number	Click here to enter text.	Click here to enter text.

14. Agreement – Date:	Click here to enter a date.
Name of Parent/Carer	Click here to enter text.	Relationship to child:	Choose a relationship
Name of Parent/Carer	Click here to enter text.	Relationship to child:	Choose a relationship
Parental Confidence in the plan achieving the outcomes on a 1-10 scale (1 being low):	Choose an item.
Setting Confidence in the plan achieving the outcomes on a 1-10 scale (1 being low):	Choose an item.
Comments:	Click here to enter text.

15. Reviews
First Review due by:	Click here to enter a date.
Who should attend:	Click here to enter text.
Is escalation likely at the review?	Yes	☐	No	☐
Date review held:	Click here to enter a date.
Summary of Review Discussion:	Click here to enter text.

Next Review due by:	Click here to enter a date.
Who should attend:	Click here to enter text.
Is escalation likely at the review?	Yes	☐	No	☐
Date review held:	Click here to enter a date.
Summary of Review Discussion:	Click here to enter text.

Next Review due by:	Click here to enter a date.
Who should attend:	Click here to enter text.
Is escalation likely at the review?	Yes	☐	No	☐
Date review held:	Click here to enter a date.
Summary of Review Discussion:	Click here to enter text.

16. Closure and Sharing
Plan closed date:	Click here to enter a date.	Closure reason:	Choose an item.
Plan passed to another setting?	Yes	☐	No	☐
Which setting if yes?	Click here to enter text.