Personal Details
Your Relationship To The Child *
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Parent
Grandparent
Foster Parent
Other
Child Details
Child's Date Of Birth (DD/MM/YYYY) *
Child's Gender *
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Male
Female
How does your child currently receive their education? *
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Maintained School (Mainstream)
Maintained School (Special)
Out Of School/College
Academy/Free School (Mainstream)
Independent School
Academy/Free School (Special)
FE College
Wholly Independent School
Education otherwise than at School
How is your child currently supported at school? *
None
Unknown
SEN Support (Former SA/SA+)
Statement Of SEN
Transition Between Statement Of SEN / EHC Plan
EHC Plan
In which Local Authority area do you live? *
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Barking and Dagenham
Barnet
Barnsley
Bath and North East Somerset
Bedford
Bexley
Birmingham
Blackburn with Darwen
Blackpool
Blaenau Gwent
Bolton
Bournemouth
Bracknell Forest
Bradford
Brent
Bridgend
Brighton and Hove
Bristol
Bromley
Buckinghamshire
Bury
Caerphilly
Calderdale
Cambridgeshire
Camden
Cardiff
Carmarthenshire
Central Bedfordshire
Ceredigion
Cheshire East
Cheshire West and Chester
City of London
Conwy
Cornwall
County of Herefordshire
Coventry
Croydon
Cumbria
Darlington
Denbighshire
Derby
Derbyshire
Devon
Doncaster
Dorset
Dudley
Durham
Ealing
East Midlands
East Riding of Yorkshire
East Sussex
Enfield
Essex
Flintshire
Gateshead
Gloucestershire
Greenwich
Gwynedd
Hackney
Halton
Hammersmith and Fulham
Hampshire
Haringey
Harrow
Hartlepool
Havering
Hertfordshire
Hillingdon
Hounslow
Hull
Isle of Anglesey
Isle of Wight
Islington
Kensington and Chelsea
Kent
Kingston Upon Thames
Kirklees
Knowsley
Lambeth
Lancashire
Leeds
Leicester
Leicestershire
Lewisham
Lincolnshire
Liverpool
Luton
Manchester
Medway
Merthyr Tydfil
Merton
Middlesborough
Milton Keynes
Monmouthshire
Neth Port Talbot
Newcastle Upon Tyne
Newham
Newport Gwent
None Given
Norfolk
North East Lincolnshire
North Lincolnshire
North Somerset
North Tyneside
North Yorkshire
Northamptonshire
Northumberland
Nottingham
Nottinghamshire
Oldham
Oxfordshire
Pembrookeshire
Peterborough
Plymouth
Poole
Portsmouth
Powys
Reading
Redbridge
Redcar and Cleveland
Rhondda Cynon Taff
Richmond Upon Thames
Rochdale
Rotherham
Rutland
Salford
Sandwell
Sefton
Sheffield
Shropshire
Slough
Solihull
Somerset
South Gloucestershire
South Tyneside
Southampton
Southend On Sea
Southwark
St Helens
Staffordshire
Stockport
Stockton-on-Tees
Stoke-on-Trent
Suffolk
Sunderland
Surrey
Sutton
Swansea
Swindon
Tameside
Telford and Wrekin
Thurrock
Torbay
Torfaen
Tower Hamlet (London)
Trafford
Vale of Glamorgan
Wakefield
Wallsall
Waltham Forest
Wandsworth
Warrington
Warwickshire
West Berkshire
West Sussex
Westminster
Wigan
Wiltshire
Windsor and Maidenhead
Wirral
Wokingham
Wolverhampton
Worcestershire
Wrexham
York
How did you hear about us?
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Did Not Ask
Declined To Say
Acorn
Another Parent
DSA
Hospital/CAMHS/Medical Professional/Therapist
Internet Search
IPSEA Event/Stall
IPSEA Staff/Volunteer
IPSEA Website
LA
MP
Newspaper/Magazine
OFSTED
Other
Other Charity
Other Website
Parent Partnership Service
Pen Green
School
SENCO
SENDIST
Social Services
Solicitors
Witherslack
Word Of Mouth
Additional Details
Is the child looked after?
Prefer Not To Say
No
By LA
By Foster Parent
Is there a history of bullying?
No
Yes
Has the child been excluded?
No Exclusions
Current Fixed Term Exclusion
Current Informal Exclusion
Permanent Exclusion
Prefer Not To Say
Previous Fixed Term Exclusion
Previous Informal Exclusion
What is the child's ethnic group?
Prefer Not To Say
White British
British Asian
Asian Bangladeshi
Black English
White European
Asian Pakistani
Mixed White/Black Caribbean
Asian Indian
Other
White Irish
Black Caribbean
Mixed White/Black African
Black African
Asian Chinese
Gypsy/Roma/Traveller
What is the family's household income?
Prefer Not To Say
< £20,000
£20,000 - £40,000
> £40,000