EMAS Early Years additional support

Step 1: Your details
Name

First name

Last name
Your position
Name of organisation/school
Telephone number
Email address
Who is this support for?

Step 2 - Further details
Has this child already been referred to the inclusion team?

Step 3 - Parental consent
Declaration
The Council hold personal data in accordance with the General Data Protection Regulation (GDPR), as set out in our Early Learning and Childcare Team Privacy Notice, which can be viewed on the menu to the right of this page under 'related documents'. Where the legal reason for processing personal information is based on consent, you have the right to withdraw the consent at any time without affecting the lawfulness of our processing prior to the withdrawal of your consent. You must notify parents that they have the right to withdraw consent by notifying the setting and early learning childcare team. You must tick one or more of the boxes below to indicate that parents agree to:
Give consent for a member of the Early Learning and Childcare team’s EAL service to observe, consult, interact through play and assess my child’s learning and development.
I agree
Understand that information will be recorded and stored in line with the Council’s data management and storage policy as detailed in the Early Learning and Childcare Team Privacy Notice.
I agree
Agree to the sharing of information between the setting, services/ professionals and other agencies that may be able to support or provide advice for my child’s development including Health Visitor, Community Nursery Nurse, Speech, Language and Communication Therapy team, ELCC inclusion team, EMAS team, translation service, social care.
I agree
Give consent for transitional information to be shared by EMAS with any setting or school that my child is due to attend.
I agree
Understand that I will be kept fully informed of the outcome of any discussions by my child’s early years setting or lead professional in a setting.
I agree

Step 4 - Pupil information
Child's name

First name

Last name
First language
Date of Birth
How long have they lived in the UK? e.g. from birth, new arrival etc.
What funding is the child receiving? Please tick all options that apply.
2 year old funding30 hours fundingEarly years pupil premium (EYPP)
Any other additional information, including the views of the child and/or family.

Step 5 - Additional support details
What support are you currently offering that's working well?
What are you worried about?
What do you expect to gain from the additional support?
Date of referral

EMAS Early Years additional support

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