SUPPORT NEEDS ASSESSMENT FORM
SNA 1 & 2: SCHOOL LEVEL
Surname and names of learner DOB: 20…./ ..... / ..... (yy/mm/dd)
ID No. .................................................
LURITS/CEMIS No. .....................................
Name of school: EMIS No.: .........................................
This is a confidential document that must be kept in the Learner Profile
CONFIDENTIAL 1
SUPPORT NEEDS ASSESSMENT (SNA 1 & 2)
(School-Level Intervention)
Both SNA 1 and 2 must be completed at school level
A Learner Profile, SNA 1 and SNA 2 will be required when support is requested from the District-based Support
Team (DBST).
SNA 1: ASSESSMENT AND INTERVENTION BY TEACHER
To be completed by the class teacher and/or subject teachers if the learner is taught by more than one teacher.
• To be completed if the Learner Profile or Screening Report or teacher observation or parent interview shows that
a learner has additional support needs.
• Captures information that will be needed when support is requested from the School-based Support Team (SBST)
by the teacher concerned.
1. AREAS OF CONCERN
Describe your concern about the learner.
When did you become aware of this? _________________________________________________
How did you become aware of this – own observation or was it reported?
How is this observation currently affecting the learner’s learning and development? Describe.
Complete the following table with regard to the learner’s scholastic profile (information extracted from Learner
Profile)
YEAR
GRADE
RESULT
(Pass/more time/
progressed)
NUMBER OF
SCHOOLS ATTENDED
Has any disability been diagnosed by a healthcare professional?
(as captured in the Medical and Health Assessment Form [Annexure D])
CONFIDENTIAL 2
If Yes, complete the following and attach reports.
Health-care Professional Date of assessment Summary of results
2. STRENGTHS AND NEEDS OF THE LEARNER
Indicate the strengths and needs of the learner by completing the sections below.
2.1 Communication:
- The learner's ability to understand what other people are saying as well as to express him/herself in a way that
other people understand – receptive and expressive language
Strengths Needs/At risk factors Support needed
2.2 Learning:
- The learner's ability to participate satisfactorily on grade level regarding subject content and assessment
Strengths Needs/At risk factors Support needed
2.3 Behaviour and social competence:
- The learner's ability to interact and work with other learners, as well as follow classroom routines
Strengths Needs/At risk factors Support needed
2.4 Classroom and school:
- Factors within the classroom and school environment (policies, ethos, attitudes, skills, resources, safety, etc.) that
are impacting on the learner's effective participation in the learning process and programmes offered at the school
Strengths Needs/At risk factors Support needed
CONFIDENTIAL 3
2.5 Family, home and community situation:
- Factors that may be impacting on the learner’s ability to achieve satisfactorily at school (e.g. family structure, family
stability, biological parents, siblings, other significant adults, orphan, child-headed household, number of schools
attended, homeless, in foster care, refugee, immigrant, substance abuse, domestic violence, divorce, neglect,
disabled/ill parents, poverty-stricken home background)
Strengths Needs/At risk factors Support needed
3. TEACHER INTERVENTIONS/SUPPORT
3.1 Curriculum Intervention:
What curriculum interventions have you as teacher implemented to address your concerns?
3.1.1 Comment on/explain how the curriculum content has been differentiated, e.g. taking into account
that every learner should have access to the grade level teaching and assessment best suited to his/her
needs. Have the learner’s needs been met by a differentiated curriculum? Have the learner’s abilities
determined what is expected of him/her without discrimination? Etc.
Successes Challenges
3.1.2 Comment on how teaching methods have been adapted/differentiated, e.g. how classroom management
has been changed to accommodate learners working at different levels of knowledge; how activities have
been modified to ensure that they are meaningful; how a range of graded materials has been used (how
material has been modified to allow for a learner’s disability, for instance); how the presentation has been
modified (e.g. by using pictures/pictures with descriptions/explanations, etc.)
Successes Challenges
CONFIDENTIAL 4
3.1.3 Comment on how the assessment has been modified, e.g. by organising the learner’s tasks, using
different methods of assessment, without compromising the curriculum standards.
Successes Challenges
3.2 What interventions have you as a teacher implemented in the learning environment (classroom/school)
to address your observations and concerns about the learner?
Comment, for example, on how the following have been modified: classroom management (e.g. culture/class rules/attitudes/
awareness of disabilities); playground management, e.g. buddy system.
Successes Challenges
3.3 Comment on how the physical environment has been modified/adapted
E.g. the seating arrangement of the learner has been changed to limit distractions, use of flexible grouping(s) to accommodate
learner, the environment has been made wheelchair-friendly.
Successes Challenges
3.4 Any additional comments that you want to make about the barrier(s) to learning experienced by the
learner, the support/interventions provided and continuing challenges that are experienced.
CONFIDENTIAL 5
3.5 What additional support/intervention do you as a teacher require from the School-based Support Team
(skills, resources, knowledge about curriculum differentiation (both in teaching and assessing)?
3.6 Schedule/Log of consultation(s) with: Parent/Legal Guardian/Caregiver/Learner himself or herself.
Date Purpose Outcome
3.7 Views expressed by Parent/Legal Guardian/Caregiver/Learner during the consultation(s):
Role player Initials and surname of person (print) Signature Date
Teacher/
20… / … / …
Manager
Parent/Legal
20… / … / …
Caregiver
Learner (if
20… / … / …
applicable)
CONFIDENTIAL 6
SNA 2: ASSESSMENT AND INTERVENTION BY SCHOOL-BASED
SUPPORT TEAM (SBST)
To be completed by the SBST in consultation with the teacher
• To be completed when requesting support from the DBST by the school
1. REVIEW
SBST reviews the information provided by the teacher: Section 1, supporting documents, verbal reporting.
1.1 Does the SBST agree with the teacher’s identification of the learner’s barrier(s) to learning, strengths
and needs/challenges? If not, provide comments:
YES NO Comments:
1.2 Does the SBST agree with the teacher’s support to deal with the barrier(s) to learning? If not, provide
comments or suggest alternative support:
YES NO Comments:
CONFIDENTIAL 7
2. SUMMARY OF IDENTIFIED BARRIERS TO LEARNING AND SUPPORT THAT WAS/
IS/WILL BE PROVIDED BY SBST
3. INDIVIDUAL SUPPORT PLAN (COMPLETED BY CLASS TEACHER AND SBST)
List the area(s) in which the support needs to be provided: Communication; Learning; Behaviour and social competence;
Health, Wellness and personal care; Classroom and school; Family, home and community; Teacher development/
training, etc. (See SNA1)
Area(s) Target Strategy of Responsible Time Review date
in which to be intervention person frame (to assess Comment
support achieved (If the learner needs concessions, achievement of on progress
or is an immigrant who needs made in
is the target)
exemptions, use Annexure B
needed If a medical condition must be achieving
investigated by a medical or other target(s)
specialist, use Annexure D)
E.g. • Assign a mentor teacher to support
Stop learner
Behaviour Within
bullying • Raise awareness during assembly Principal 15 April 20…
and social • Review school conduct policy a week
behaviour
competence • Call in the parent/legal caregivers
CONFIDENTIAL 8
