UMnyango WezeMfundo
Department of Education
Lefapha la Thuto
Departement van Onderwys
Circular 75/2007
Date: 25 October 2007
Topic
Management of Admissions to
Public Special and Specialised
Schools/Classes for 2008
Enclosures
Annexure A: Appeals Form
Annexure B: Enrolment and Waiting List
Annexure C: Inclusion and Special Schools
Referral Form
Distribution
All Chief Directors and Directors at Head Office
and District Offices;
Principals and staff of all public ordinary and
special and specialised schools;
Members of School Governing Bodies;
Teacher Organisations and Unions; and
Relevant Non-Governmental Organisations
The information must be forwarded to all
learners, parents and caregivers
Enquiries
Directorate: Inclusion and Special Schools
(011) 355 0728 or (011) 355 0836
On request, this circular will be made available in Afrikaans, isiZulu or Sepedi within 21 days
Also available on the GDE website at: www.education.gpg.gov.za
Office of the Head of Department
Tel: (011) 355 1511
Room 1009, 111 Commissioner Street, Johannesburg, 2001
PO Box 7710, Johannesburg, 2000
Fax: (011) 333 5546
E-mail: [email protected] OR [email protected]
MANAGEMENT OF ADMISSIONS TO PUBLIC SPECIAL
AND SPECIALISED SCHOOLS/CLASSES (PSSSC) FOR
2008
1.
PURPOSE
The purpose of this circular is to:
1.1
1.2
1.3
1.4
align the provincial admissions processes with the latest legislation;
replace circular 43/2005;
advise principals and staff of all public ordinary and PSSSC on
administrative procedures for admission of learners to PSSSC; and
refer principals and School Governing Bodies (SGBs) to the relevant
legislation to ensure compliance with admission into special and
specialised public schools and classes.
2.
INTRODUCTION
2.1
This circular outlines the management procedures and processes for
admission of learners to PSSSC for the year 2007/8.
2.2
In revising and aligning the admission process, the GDE focussed on
applying the relevant legislation and by supporting the principles of
access, equity, redress and the prevention of unfair discrimination through
responsible inclusive education practices.
3.
LEGISLATIVE/POLICY FRAMEWORK
3.1
The Constitution of the Republic of South Africa, 1996 (Act No. 108 of
1996), as amended.
3.2
National Education Policy Act, 1996 (Act No. 27 of 1996), as amended.
3.3
South African Schools Act, 1996 (Act No. 84 of 1996) (SASA), as
amended.
3.4
Gauteng School Education Act, 1995 (Act No. 6 of 1995), as amended.
3.5
Admission of Learners to Public Schools (General Notice 4138 of 2001).
3.6
Education White Paper 6: Special Needs Education (Building an Inclusive
Education and Training System, 2001. (Notice No. 703 of 27 July 2001).
3.7
National Curriculum Statement Grades 10 – 11 (general) Policy.
Government Gazette Volume 460, No. 25545 of October 2003.
English: Page 2 of 22
3.8
C2005 Revised National Curriculum Statement Grades R-9 (Schools)
Policy. Government Gazette Volume 443, No. 23406 of May 2002.
3.9
Health Professions Act, 1974 (Act No. 56 of 1974) as amended.
Government Gazette No. 26497 of 2 July 2004.
3.10
Children’s Act, 2005 (Act No. 38 of 2005) as amended. Government
Gazette Volume 492, No. 28944 of 19 June 2006.
3.11
Aliens Control Act, 1991 (Act No. 96 of 1991), as amended.
Principals and School Governing Bodies must familiarise themselves with the
legislation mentioned in paragraph 3 and the contents of this circular.
4.
MANAGEMENT PROCEDURES OF ADMISSION
4.1
The Role of the Head of Department (HOD)
4.1.1 Section 5(7) of the South African Schools Act, 1996 (SASA), (Act No. 84 of
1996, states that:
“application for the admission of a learner to a public school must be made
to the education department in a manner determined by the Head of
Department."
4.1.2
In order to comply with the above mandate, the HOD of the Gauteng
Department of Education (GDE) has established the structures listed
below and developed processes and procedures to be followed during the
admission process.
4.1.3
The following structures have been established:
4.2
(a)
The District Admissions Teams for Special and Specialised
Schools/Classes (DATSSS). The DATSSS team comprises of
district officials and specialist personnel from special and specialised
schools.
(b)
The Provincial Admissions Team for Special and Specialised
Schools (PATSSS). The PATSSS team comprises of Head Office
and district officials.
Specialist personnel from special and
specialised schools will be accessed, whenever a need arises.
The Role of the District Director
The Head of Department (HOD) of Education hereby delegates the
responsibility for the administration of admissions at PSSSC to the District
Director in the following areas:
English: Page 3 of 22
4.2.1
Establish and manage DATSSS.
4.2.2
Co-ordinate and monitor the admissions and registration procedures for
PSSSC at district level.
4.2.3
Co-ordinate late registration, as well as registration of transferred learners
throughout the year.
4.2.4
Monitor the non-attendance of learners of compulsory school-going age at
special and specialised schools/classes.
4.2.5
Ratify and certify the School Admissions Policy submitted by the School
Governing Body.
4.3
The Role of the Principal of the Special and Specialised School/Class
The HOD hereby delegates the responsibility for the administration of the
admission of learners to PSSSC to the principal. The principal has to
ensure that the administration of admissions is carried out procedurally
and in line with the stipulations in this circular and related legislation.
The school principal of the PSSSC is responsible for the following:
4.3.1
Make available application forms for admission and the admission policy
of the school to all parents on request.
4.3.2
Ensure that the School-Based Support Team (SBST) reviews and
analyses the admissions form, the learner profile, the referral form, the
GDE Support Form and other supporting documents to arrive at
recommendations for the learner requesting admission at the school.
4.3.3
Ensure that the analysis of the documents focuses on the level and type of
support required, as well as specialist programmes and resources
required.
4.3.4
Ensure that no learner is subjected to a week-long assessment for
admission purposes.
4.3.5
Refrain from insisting on testing/evaluation by professionals, both inside
and outside the employment of the school/GDE for admission purposes.
4.3.6
Acknowledge reports from private practitioners as supplementary sources
of information.
4.3.7
Assist parents in completing the application form when such assistance is
required.
4.3.8
Ensure that all the required forms are attached and correctly completed.
English: Page 4 of 22
4.3.9
Receive and process the completed application forms from the parents.
4.3.10 Forward all applications, together with the recommendations and all the
required and supporting documents, to the DATSSS.
4.3.11 Facilitate the recommendations of the DATSSS and PATSSS.
4.3.12 Contact parents and inform them about the outcome of the application in
writing.
4.3.13 Keep a register of all applications.
4.3.14 Liaise with the DATSSS co-ordinator.
4.3.15 Forward the enrolment and waiting list (Annexure B) to the DATSSS coordinator by the last Friday of each school term.
4.3.16 Provide parents with a dated letter indicating place on the waiting list for
grades/class for a specific year.
4.3.17 Remind parents to update contact numbers and to contact the school
regularly to confirm the need for placement.
NOTE:
A.
B.
C.
4.4
It is not the function/role of the principal or the School-Based
Support Team (SBST) or a Multidisciplinary Team at the school to
determine whether a learner is to be admitted to a school or not. The
responsibility of determining whether a learner may be admitted to a
specific special or specialised school rests with the DATSSS and/or
PATSSS.
It is not the function or role of the principal to declare the class,
phase or school full. The latter can only be declared full by the
District Director.
In the event that there is relocation of the family, a learner who is
already in a special or specialised school/class should get
preference for admission into the nearest appropriate school.
Role of the School Governing Body (SGB)
It is the role of the SGB to:
4.4.1
Determine the admission policy of the school in terms of relevant
legislation and this circular.
4.4.2
Submit the School’s Admission Policy to the District Director by the end of
April of each year for ratification and certification.
English: Page 5 of 22
4.4.3
Inform all parents of learners admitted to the school of their rights and
obligations in terms of the SASA and all applicable national and provincial
policies, legislation, rules and regulations.
4.4.4
Ensure that the SGB does not administer any test relating to the
admission of a learner to a public school, or direct or authorise the
principal of the school or any person to administer such a test (SASA).
4.5
The Role of Parents
4.5.1
Liaise with the School-Based Support Team (SBST) on the performance
of the learner, and to consider the recommendations furnished.
4.5.2
To lodge an appeal with the MEC, if he/she is dissatisfied with the
decision taken by DATSSS.
4.5.3
Avail him-/herself for consultation between the principal, SBST, DATSSS,
and/or PATSSS as required.
4.5.4
Support their children to attend school regularly.
4.6
Role of the Principal of the Ordinary Public School (Referring
School)
It is the role of the principal of the school referring a learner to ensure:
4.6.1
That the SBST engages with all relevant information regarding the learner,
consults with the parents, provides support to the educator and makes
recommendations to place the learner to a special and specialised school
only after all efforts to assist the learner have been made.
4.6.2
That the recommendation, together with all relevant information, including
the completed Inclusion and Special Schools Referral Form (ISSRF), the
GDE 450 support form, is forwarded to the DATSSS.
4.7
The Role of DATSSS
4.7.1
Receive all the application forms for admission into special and
specialised schools.
4.7.2
Assess the applications to determine the optimum support the learner may
require and to identify where and how this can be accessed.
4.7.3
Base the recommendations on the ISSRF and the GDE 450 form,
indicators of need, access to curriculum and levels of support required.
English: Page 6 of 22
4.7.4
Facilitate the admission of learners into special and specialised schools,
both within the district, and across districts.
4.7.5
Avail themselves for other applications throughout the course of the year.
4.7.6
Ensure that proper referral processes have been followed by the school.
4.7.7
Manage the waiting list.
4.7.8
List of names of DATSSS officials:
District
Gauteng North
Gauteng West
Tshwane North
Tshwane South
Tshwane West
Ekurhuleni South
Ekurhuleni North
Gauteng East
Sedibeng East
Sedibeng West
Johannesburg East
Johannesburg
North
Johannes burg
Central
Johannesburg
South
Johannesburg
West
Head Office: ISS
Head Office: ISS
Head Office: ISS
Name of ESS
Representative
C. Kitching /
F. Burger
F. Sizane /
W. Engelbrecht
R Jacobs/
S. Pretorious
Onicca Pitsi/
Lawrence Makondo
M. Stroom
Sally Mothusi/
Binky Lebata
M. Nhlapo / Dr. Vermeulen /
L. v.d. Westhuizen
Dr. Henk Joubert
H. Matjeke/
T. Nhlapho
M. Mazibuko/
L. Magubane
N. Ameen/
T. Chokoe
L. Strydom/
E. Bosch/
J Singh
E. Beukes/
L Potgieter
T. Erasmus/
C. Cox
E. Smith
N. Manga
L. Joubert
Tel. no
(012) 326 6817
(011) 693 4904
(012) 323 9083
(012) 400 4885
(012) 400 4839
(012) 701 5229
(011) 389 6261
(011) 746 8155
(011) 746 8059
(016) 421 4175
(016) 440 1854
(016) 933 3300
(011) 666 9165
(011) 666 9074
(011) 694 9552
(011) 983 2110
(011) 983 2112
(011) 854 6421
(011) 831 5426
(011) 831 5314
(011) 355 0365
(011) 355 0728
(011) 355 0845
English: Page 7 of 22
4.8
The Role of the PATSSS
4.8.1
Co-ordinate the process of admissions of learners to special and
specialised schools.
4.8.2
Facilitate case conferences, and keep records of such case proceedings
for future reference.
4.8.3
Make the final recommendations for all appeals and inter-district
admissions of the learners.
4.9
Placement of Learners from Special and Learning Support Settings
4.9.1
Learners who are already in a special and specialised setting should be
given priority for placement as they are already in the special and
specialised system of education.
4.10
Registration and Admission of Learners
4.10.1 The registration process may continue throughout the year. However, it is
recommended that the majority of learners be registered during the period:
July to September 2007.
4.10.2 The PATSSS team will meet monthly or as the need arises to facilitate
applications received for admission into special and specialised schools
across the districts.
4.11
Exemption of Compulsory School Attendance
4.11.1 All applications related to the above must be forwarded to the DATSSS in
writing.
4.11.2 The Head of Department will make a final decision on whether to grant
permission for exemption of compulsory school attendance.
4.12
Admission of Foreigners and Asylum Seekers
4.12.1 The above procedures and processes also apply to learners who are not
citizens of the Republic of South Africa and whose parents are in
possession of a permit for temporary or permanent residence issued by
the Department of Home Affairs.
4.12.2 A learner who has entered the country must present the study permit on
application to the school.
4.12.3 Persons classified under legislation as illegal aliens must, when they apply
for admission into special and specialised schools for their children, show
English: Page 8 of 22
evidence that they have applied to the Department of Home Affairs to
legalise their stay in the country in terms of the Aliens Control Act, 1991
(Act No. 96 of 1991). The school should offer assistance in this regard.
4.13
Appeals
4.13.1 A parent who is dissatisfied with the decision of the DATSSS/PATSSS
may appeal against the decision of these structures to the Member of
Executive Council (MEC). (See Annexure A.)
4.13.2 The MEC will, however, refer any query back to the DATSSS/PATSSS
should the required form and accompanying letter from the school not be
completed.
5.
CONCLUSION
5.1
This circular supports the promotion of equal, non-discriminatory access to
learning intervention and support to all those learners that require such
support.
5.2
The information contained in this circular must be forwarded to all
learners, parents and caregivers.
_____________________
MALLELE PETJE
HEAD OF DEPARTMENT
English: Page 9 of 22
Annexure A
Appeals Form
UMnyango WezeMfundo
Department of Education
Lefapha la Thuto
Departement van Onderwys
APPEAL TO THE MEMBER OF THE EXECUTIVE COUNCIL
Appeal against the decision of the Head of Department to confirm the decision of
the Provincial Admissions Team for Special and Specialised Schools (PATSSS) to
refuse admission of a learner to a public special or specialised school.
Please note that such an appeal must be lodged with the Member of the Executive
Council within 15 days of being notified by the Head of Department that he or she
has confirmed the decision the PATSSS to refuse admission of a learner to a
public special or specialised school.
A.
DETAILS OF LEARNER WHO HAS BEEN REFUSED ADMISSION
NAME:
................................................................................................
AGE IN YEARS:
................................................................................................
DATE OF BIRTH:
................................................................................................
IDENTITY NO.:
................................................................................................
ADDRESS:
................................................................................................
(if not living with the
person lodging the ................................................................................................
................................................................................................
POSTAL CODE:
................................................................................................
English: Page 10 of 22
B.
DETAILS OF PERSON LODGING THE APPEAL
NAME:
................................................................................................
RELATION TO LEARNER (e.g. father, mother, guardian, custodian or person
responsible for the education of the learner)
................................................................................................
ADDRESS:
................................................................................................
................................................................................................
................................................................................................
POSTAL CODE:
................................................................................................
CONTACT NUMBERS: .............................................................................................
C.
DETAILS OF SCHOOL WHERE ADMISSION WAS REFUSED
NAME:
................................................................................................
ADDRESS:
................................................................................................
................................................................................................
................................................................................................
POSTALCODE:
................................................................................................
TELEPHONE:
................................................................................................
NAME OF
PRINCIPAL:
................................................................................................
D.
DETAILS OF APPLICATION FOR ADMISSION
DATE OF APPLICATION
FOR ADMISSION: ................................................................................................
GRADE FOR WHICH
ADMISSION WAS SOUGHT:....................................................................................
English: Page 11 of 22
E.
REQUIRED DOCUMENTATION
When you applied for admission to the school, did you
1.
Complete all of the documents handed to you by the school? (Answer Yes
or No)
………………
2.
Submit the following? (Answer Yes, No or Not Applicable in each case):
2.1
a certified copy of the official birth certificate of the learner.
.....................
2.2
proof that the learner has been immunised against polio, measles,
tuberculosis, diphtheria, tetanus, and hepatitis B.
………………
2.3
the transfer card of the learner, if he or she was enrolled at another
school.
………………
the most recent school report of the learner, if he or she was enrolled
at another school.
………………
2.4
3.
If you were not able to supply the documentation referred to in (2), did the
principal advise you where to obtain the necessary documentation?
(Answer Yes, No or Not Applicable)
………………
4.
If the learner has entered the country on a study permit, was the study
permit presented to the school when admission was sought? (Answer Yes,
No or Not Applicable)
………………
5.
If you were not able to supply the documentation referred to in (4), did the
principal advise you where to obtain the necessary documentation?
(Answer Yes, No or Not Applicable)
………………
F.
DETAILS OF REFUSAL OF ADMISSION
When the learner was refused admission to the school, did you
1.
Receive, in writing from the PATSSS via the school principal, reasons for
the refusal of admission? (Answer Yes or No).
………………
English: Page 12 of 22
2.
Receive, from the school principal, the address of the Member of the
Executive Council for Education in Gauteng? (Answer Yes or No)
………………
Please state briefly, in the spaces below, what the reasons for the refusal of
admission were.
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
Have you received, from the Head of the Gauteng Department of Education,
written confirmation of the decision of the PATSSS to refuse admission? (Answer
Yes or No)
………………
Are you satisfied with the reasons for the refusal of admission, as given by the
PATSSS? (Answer Yes or No)
………………
Please state briefly, in the spaces below, what your reasons for dissatisfaction are.
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
Are you satisfied with the written confirmation of the decision of the PATSSS to
refuse admission, as supplied by the Head of the Gauteng Department of
Education? (Answer Yes or No)
………………
Please state briefly, in the spaces below, what your reasons for dissatisfaction are.
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
English: Page 13 of 22
G.
ADDITIONAL INFORMATION
Please give any additional information with regard to this Appeal in the spaces
provided below.
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................
H.
DOCUMENTATION TO BE SUBMITTED
Certified copies of all the documentation and correspondence relevant to the
refusal of admission must be submitted with this Appeal.
I.
DECLARATION
I declare that all the information supplied in this document is true and accurate.
.......................................................................
Signature
..........................
Date
English: Page 14 of 22
Annexure B
UMnyango WezeMfundo
Department of Education
Lefapha la Thuto
Departement van Onderwys
ENROLMENT AND WAITING LIST
Name of School:
_________________________________________________
EMIS number:
__________________
District: ____________________
There are two parts to this Section. Schools are required to complete the
tables below, and forward the information to the district office, for attention:
Inclusion and Special Schools Co-ordinator.
Part A: The Enrolment List
This part of the waiting list must give an indication of statistics relating to
admissions to the school.
Grade
Actual number
of learners
who can be
accommodated
Actual
number of
learners
admitted
Number of
“spaces”
available
Number of
learners on
waiting list
Comments
English: Page 15 of 22
Part B: The Waiting List
This part must indicate details of the learners on the waiting list of the number of
places available in the school. Part B outlines a list of learners who have been
identified as candidates for the school, but the school has no place.
Name of Learner
Age of
Learner
Last
grade
attended
Grade in
which
admission
is sought
Comment
English: Page 16 of 22
Annexure C
UMnyango WezeMfundo
Department of Education
Lefapha
Lefapha la Thuto
Departement van Onderwys
INCLUSION AND SPECIAL SCHOOLS REFERRAL FORM (ISSRF)
Strictly Confidential
To be completed for every learner for whom you require support from the
Directorate: Inclusion and Special Schools
District Ref. No: _____________.
Name of Referring School/Institution: ....................................................................................
Contact Person/SBST Co-ordinator: ......................................................................................
Telephone no: Code (…..) ………………. ...........................................................................
Fax no:
Code (…..) ……… .......................................................................................
Cellular no:.:………………………..E-mail address:................................................................
A.
IDENTIFICATION DETAILS OF LEARNER
Surname
..............................
Name(s):.................................................................
Date of birth ..............................
Age: years .................................months.………….
Grade
..............................
Age of admission to Grade 1 ..................................
Gender
..............................
Language spoken at home ....................................................................................................
Name of School attending/last attended: ...............................................................................
Contact Person: .....................................................................................................................
Telephone no: Code (….) ………………. ............................................................................
Fax no:
Code (…..) ……… .......................................................................................
Cellular no:.:………………………..E-mail address:................................................................
English: Page 17 of 22
B.
FAMILY DETAILS
Position of child in family:…………of……………..children.
Personal Particulars of Parent(s) / Guardian(s)
Mother/Guardian: ....................................
Marital Status:
....................................
Employment Status:...................................
Employer:
....................................
Position
....................................
Telephone no.:
Code (…..) .................
Fax no.:
Code (…..) .................
Residential Address: ...............................
....................................
....................................
Code ...........................
Telephone no.:
Code (…..) .................
Fax no.:
Code (…..) .................
Cellular no:
....................................
E-mail address:
.............................. .....
C.
Father/Guardian: ............................................
Marital Status: ............................................
Employment Status: .......................................
Employer:
............................................
Position:
............................................
Telephone no.: Code (…..) … .....................
Fax no.:
Code (…..) .........................
Residential Address: ...................................
............................................
............................................
Code:… ..............................
Telephone no.: Code (…..) … .....................
Fax no.:
Code (…..) .........................
Cellular no:
............................................
E-mail address: ............................................
MEDICAL / THERAPEUTIC / COUNSELLING / REMEDIAL / SUPPORT
INFORMATION (Attach reports if/when available)
PROFESSIONAL
Medical Practitioner:
COMMENT
....................................................................................................
....................................................................................................
Psychiatrist
....................................................................................................
....................................................................................................
Neurologist:
....................................................................................................
....................................................................................................
Psychologist:
....................................................................................................
....................................................................................................
Occupational Therapist:
....................................................................................................
....................................................................................................
Speech Therapist:
....................................................................................................
....................................................................................................
Learning Support Educator: ...................................................................................................
....................................................................................................
Other:
....................................................................................................
....................................................................................................
History: If there is any illness, physical challenge, traumatic experience or crisis, note
briefly, and mention the attention given. Attach reports if/when available.
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
English: Page 18 of 22
D.
SCHOLASTIC RECORDS
Please provide a full scholastic record of two years.
GRADES 1 – 9 (GET)
PREVIOUS YEAR
CURRENT YEAR
PREVIOUS YEAR
CURRENT YEAR
Language 1
Ist Additional Language
2nd Additional Language
MLMMS (Maths)
Natural Sciences
Technology
Arts and Culture
Life Orientation
Econ.& Man. Sciences
Social Sciences
GRADES 10 – 12
FET subjects
English: Page 19 of 22
Competencies
Please note barriers experienced in the following areas:
COMPETENCY
LANGUAGE SPOKEN AT
HOME
LANGUAGE OF TEACHING
AND LEARNING
ORAL
COMMUNICATION
• Understanding
• Instruction
• Ability to express
needs
READING
• Level of
competency.
Phonics and
words
WRITING
• Word identification
• Ability to write
sentences
MATHEMATICAL
• Ability to add
• Ability to subtract
• Ability to divide
• Ability to multiply
Language of learning and teaching:
...........................................................................
Number of schools attended:
...........................................................................
Admission date to current school:
...........................................................................
Number of years in current grade:
...........................................................................
Number of years retained:
...........................................................................
Number of years retained in current grade: ...........................................................................
Which grades were repeated?
...........................................................................
In which grades was the learner condoned:...........................................................................
In which grades has the learner progressed: .........................................................................
Number of days absent during current year:..........................................................................
English: Page 20 of 22
E.
EMOTIONAL / BEHAVIOURAL STATUS
Indicate on a 5-point scale your findings/observations regarding the learner. Circle
the appropriate number: 1 denotes a low score and 5 a high score.
LOW SCORE
DESCRIPTION
HIGH SCORE
DESCRIPTION
5-POINT SCALE
Emotionally mature,
stable, realistic
1
2
3
4
5
Emotionally immature,
Unstable
Moderate behaviour
1
2
3
4
5
Aggressive
Persevering
1
2
3
4
5
Casual
Confident
1
2
3
4
5
Discouraged
Makes own decisions
1
2
3
4
5
Group follower
Relaxed
1
2
3
4
5
Tense
Accepts authority
1
2
3
4
5
Disruptive behaviour
F.
PARENTAL CONSULTATION
Has the parent(s) / guardian(s) been consulted on the learner’s challenge(s)?
If Yes, state dates:
Date of initial consultation:
Subsequent consultation:
Subsequent consultation:
Subsequent consultation:
Subsequent consultation:
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
....................................................................................................
If No, state reason:
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
G.
INTERVENTION
Concerns observed by referring educator:
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Intervention by referring educator:
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Intervention by referring School-Based Support Team (Please include the dates):
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Outcomes and recommendations from the Intervention/SBST:
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The following signatories declare that the above information is correct and has been
kept confidential. Information has been shared only for developmental purposes.
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Referring Educator
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Name and Surname in Print
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Date
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SBST Co-ordinator.
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Name and Surname in Print
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Date
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Principal/Head of School
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Name and Surname in Print
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Date
Outcomes and recommendations from the ISS Co-ordinator:
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ISS Co-ordinator
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Name and Surname in Print
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Date
English: Page 22 of 22