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This form can be completed by children aged between 12 and
15 years, who want to make a reference to the Additional
Support Needs part of the Tribunal - we call this “the Tribunal”
in this form.
Make a Reference
Page 1 of 13
Hello!
Welcome to the Additional Support Needs part
of the Tribunal. We call this “the Tribunal” in
this form. You can check our “needs to learn”
website (coming soon) for word meanings and
other help.
You are not on your own. The Tribunal’s staff are
here to help you.
There are two types of reference you can make to the Tribunal:
A co-ordinated support plan (CSP) type; or
A reference appealing against your education
authority’s decision about your capacity or
wellbeing.
To do this, please fill in this form.
If you think you have not been treated fairly at school
then you can make a Claim.
To do this, you will need to fill in the “Make a Claim”
form which is available on our “needs to learn”
website at this link
.
To help you fill in this form please read the Children’s
Guide on How to Make a Reference which is
available here.
Page 2 of 13
Your Contact Details
So that we can contact you about your reference
please tell us your:
Name:
Date of Birth:
Address:
Telephone number:
Mobile:
Email address:
The law says that the Tribunal can only send certain
information by email. The Tribunal may need to send
you information by post.
Page 3 of 13
Your Parent/Carer/Guardian’s
contact details
You don’t have to tell us this, but it helps us, if
your parent/carer/guardian decides to come to the hearing.
Please tell us your parent, carer or guardian’s contact details.
Name:
Relationship to you:
Address:
Telephone number:
Mobile:
Email address:
Your Education Authority
Which Education Authority is your reference about?
Name of Education Authority:
Name of contact person at Education Authority:
:
Address:
Town/City:
Postcode:
Telephone number:
(If you are not sure what an Education Authority is
then please read page 7 of the Guide on How to
Make a Reference before completing this section.)
Page 4 of 13
Your Additional Support Needs
Some children need extra help at school so they
can get the most out of their education. This is
called having additional support needs.
Explain what your additional support needs are:
There are lots of reasons why you might have
additional support needs. Please read page 8 of the
Children’s Guide on How to Make a Reference for
more information.
Page 5 of 13
Your Reference
You must send this form to the Tribunal within 2 months from
the date of the decision or failure that your
reference is about.
To understand more about the different types of
references you can make and what information
the Tribunal wants to know please read page 9
of the Children’s Guide on How to Make a
Reference.
Explain what your Education Authority has done (or not done)
which you disagree with and why you want to make a
reference:
Page 6 of 13
Page 7 of 13
Your Supporting Information
Please enclose any documents you think would
help the Tribunal to understand your reference.
Is there anything else which you would like to tell the
Tribunal to help them understand your reference?
You can write here the name and contact
details of any people (we call them
“witnesses”) you want to speak to the
Tribunal.
Please tell us their name, the position
they work in and their address + phone
and email details.
Page 8 of 13
Your Voice!
Your voice, feelings and opinions matter.
The Tribunal will do its best to help you
overcome any difficulties that you have when
making your reference.
Please tell us if you have communication difficulties or other
support needs.
What can the Tribunal do to help you with these during the
hearing?
Page 9 of 13
Page 10 of 13
Your Representative
To help make sure the Tribunal hears your views,
you have the right to have someone who will act
as your representative.
Please tell us your representative’s contact details:
Name:
Job Title:
Organisation:
Address:
Telephone number:
Email address:
Page 11 of 13
Your Supporter
As well as a representative, you can have
someone attend the hearing with you, to support
you.
If you want more information about the role of a
representative or a supporter, or you do not have a
representative or supporter, please see pages 12
and 13 of the Children’s Guide on How to Make
a reference.
Please tell us your supporter’s details
Name:
Address:
Telephone number:
Email address:
Last bit
Please read over the form and check that you have answered
all of the questions.
Once you have completed the form please sign here:
Your signature
Date
Thank you for filling in this form.
You need to send this form and all supporting information to
the Tribunal. You can do this by email or post.
Our contact details are:
Additional Support Needs, Health and Education Chamber
First-tier Tribunal for Scotland
Glasgow Tribunals Centre
20 York Street, Glasgow, G2 8GT
email: ASNTribunal@scotcourtstribunals.gov.uk
Page 12 of 13
What happens next?
We will read your form to see if the Tribunal can help with the
matters you have raised.
We will then contact you to update you on what will happen
next and, if necessary, ask you for more information.
For more information about what happens next,
please visit our “needs to learn” (coming soon)
website which has lots of useful information.
If you have any questions you can contact us on:
0141 302 5860.
Page 13 of 13
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Completed 5 February 2021

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