School Reference Form - Devonshire House

Reference Request Form for Devonshire House School

This field is for validation purposes and should be left unchanged.

We kindly ask you to complete the below reference form in support of an application to Devonshire House from a child at your current educational setting.

As we do not have a 4+ assessment as part of our admissions process to the School, and whilst families have also been asked the questions below, any further information you can provide will be invaluable to us and the transition of the child to our school.

Please complete all questions to the best of your knowledge and with as much detail and up to date information as possible.

Where applicable, the Admissions Team may contact you separately upon completion of this form to arrange for a member of the SEN Department to visit the child in your setting, or to arrange a meeting with you to discuss the child’s application further. Should you have any questions regarding the form, or if you wish to discuss any of the below or the child’s application to the school in more detail via a confidential call or meeting, please contact admissions@dhprep.co.uk.

Your Details

Who is completing this form?

Person Completing this Form(Required)

Title (Mr, Mrs, Dr...) First Name Last Name

Current Place of Employment(Required)

Your Position at Your Place of Employment(Required)

Work Email Address(Required)

Work Contact Number(Required)

Child's Details

Child's Name(Required)

First Name Middle Name(s) Last Name

Current Year Group/Class(Required)

Character Reference

What is Your Relationship to the Child?(Required)

How Long Have You Known the Child For?(Required)

Please share some details regarding the child’s personality and characteristics that you think would be an asset to Devonshire House. Please provide examples where appropriate

Learning Profile

To the best of your knowledge, does the child have any diagnosed, undiagnosed, pending, or suspected special educational needs, disability, or other conditions that requires any additional support?(Required)

If YES, Please provide further details, including any support measures you currently have in place to support the child. If you have any reports you are able to share, please attach these in the appropriate section below:

Please upload files here

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 128 MB.

Development Information

To the best of your knowledge, is the child independent in all areas of self-care, such as feeding, toileting, and dressing?(Required)

If NO, Please provide details on areas where the child still requires assistance

To the best of your knowledge, has the child experienced any delays to their speech and language, or gross and fine motor skill development?(Required)

If YES, Please provide further details including any support measures (such as OT or SaLT) you currently have in place to support the child. If you have any reports you are able to share, please attach these in the section below

Please upload files here

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 128 MB.

To the best of your knowledge, are you aware of any other information that may have impacted the child’s development, such as travel, a recent move, bereavement, or parents working away, etc?(Required)

If YES, Please provide further details(Required)

Medical Information

To the best of your knowledge, does the child have any medical conditions?(Required)

If YES, Please provide further details, including any measures you currently have in place to support the child at your setting(Required)

To the best of your knowledge, does the child have any allergies, or take regular prescribed medication?(Required)

If YES, Please provide further details(Required)

Any Further Details

Please use this section to detail any other information you wish to share that you think we should consider as part of the child’s application to the school.

Date Form Completed