SUPPORT NEEDS ASSESSMENT FORM
SNA 1 & 2: SCHOOL LEVEL
Surname and names of learner DOB: 2026. / ..05.. /13 (yy/mm/dd)
RAISIBE CHAUKE
ID No.1601060038087
LURITS/CEMIS No. .....................................
Name of school: GAUTENG WEST PS EMIS No.: ..70025262..
CONFIDENTIAL
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.
Joyce is unable to read and write with comprehension
Joyce is diagnosed with ASD/ADHD
Joyce cannot recognize sounds
Joyce has a short concentration span
When did you become aware of this? March 2026
How did you become aware of this – own observation or was it reported?
During baseline assessment/ class activities/ oral assessment/observation/
parent interview/ information from the previous educator
How is this observation currently affecting the learner’s learning and development? Describe.
She is performing below her grade level.
Her self-esteem is affected and her behavior is starting to change.
Complete the following table with regard to the learner’s scholastic profile (information extracted from Learner
Profile)
YEAR 2022 2023 2024 2025 2026
GRADE 1 1 2 3 3
RESULT Retained Progressed Achieved Retained
(Pass/more time/
progressed)
NUMBER OF 1
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
Dr White 12/01/2023 ASD and ADHD, Report Is Attached.
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
Strong verbal communicator Barriers to non-verbal communication, Assist in developing social skills. Speech
speech impairment, unwillingness to therapy, teach to use dictionary, buddy
participate in class discussions, system.
Knows how to bring points across, inability to stay on topic, talk nonstop, Oral at teacher ‘s desk, Assist in preparing
Understand verbal affects focus and listening ability orals, Apply for concession for orals. Short
communication, communicates and specific and direct instructions.
clearly, confident communicator,
understand one instruction at a
time,
Frame appropriate question. Difficulty following multistep instruction. Use auditory ques.
Sometimes responds to cues to Sometimes lose track, and communication Writing: pencil grip and fine motor skills
keep track, has partial is not logical. activities. Throwing and catching, picking
understanding. Emotionally small objects.
intelligent: pick upon verbal cues
Struggles to concentrate on tasks, shy to
ask questions.
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
Comprehend concepts Cannot write and read. Apply for accommodation/concession.: two
letters and three letters. Gross and fine
motor skills training activities
Participate orally, Cannot read because of sight, cannot Referral to clinic/hospital/ Social
comprehend because of hearing problems. development: Social worker
Cannot concentrate because of medical
diagnosis: ADHD/ASD
Copy from the board
Participate in group activities by Cannot recognize sounds and letters Teach letter sounds and simple words
interaction.
Good in drawing pictures Cannot basic mathematics computation, Teach basic math, simple numbers,
cannot comprehend concepts addition, and subtraction of 1-digit
numbers: mental math
2.3 Behavior 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
Obeys class rules, good social Untidy and disorganized. Challenges class Keep behavioral record. Develop behavior
skills, cooperation in class, helpful rules, inconsiderate towards others. support plan, discuss with parents, give
in class Procrastinate. Disruptive in class, overly responsibility to the learner.
emotional, Does not realize how actions
affect others
Good time management, well Bullying, swearing. Challenge sticking to Anti bullying programmed, clear class
organized. class rules. Victim mentality, Withdrawn, rules. Set routines, Clear consequences
CONFIDENTIAL 3
Not always willing to participate. Shouts with, establish clear social rules
out constantly
Can play with others. Poor social skills, challenges, authority, Compile behavior contract.
disrespectful.
Good social skills. Positive self-
deficiency. Good value system.
Respectful towards peers,
participate in group discussion,
Emotionally mature.
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
Charts and posters on the wall Overcrowded Class. Small groups arrangement.
Learner sits next to the teacher’s Lack of resources Procurement of support resources.
desk for better control and focus
Sitting arrangement per ability: Lack of focus and easily distracted.
Visible class rules coupled with
the demerit system.
CONFIDENTIAL 4
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
Healthy, always clean, and well Chronic disease, asthma, diabetes, depression Make sure asthma pump or the learner has
presented medication at school.
Rarely absent, participate in sports Sensory impairment: wears glasses, hearing Discuss with parents to ensure involvement.
aids. Appears neglected, Possibility of abuse, Complete SNA, abuse/ neglect: complete
poor hygiene, regularly absent form 22
Healthy eating habits, Good personal No parent involvement, Poor socio-economic
hygiene, emotionally well adjusted. circumstances.
Neat in appearance circumstances,
Socio economic, Parents are
involved.
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
Intentional planning with individual learners in mind, assess Overcrowded classes do not allow individual attention,, lack
prior learning, buddy system, cooperative learning, of space limits group work, lack of teaching resources.
differentiation.
Differentiation in assessments, weekly reflections Learner struggles to keep up, Disruptive learners due to
overcrowding,
Constant motivation, adjust pace : allow extra time for Individual learning makes a learner feel self-conscious
projects
Explaining instructions in more than 1 way allows learners Overload of administrative responsibilities.
to take ownership of their learning by making choices. Use
variety of teaching methods.
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 5
3.1.3 Comment on how the assessment has been modified, e.g., by organizing the learner’s tasks, using.
different methods of assessment, without compromising the curriculum standards.
Successes Challenges
3.2 What interventions have you implemented as a teacher 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 made wheelchair friendly.
Successes Challenges
3.4 Any additional comments that you want to make about the barriers(s) to learning experienced by the
learner, the support/interventions provided and continuing challenges that are experienced.
CONFIDENTIAL 6
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 7