SECTION 1: BASIC INFORMATION

Name of Pupil DOB

Male/female Year Group

Foster carer or key worker

Address

Telephone no

Social Worker/Team Telephone no

Team Manager

Address

Parents/other addresses to which reports etc. should be sent

Name

Name

Name

(relationship to pupil) (relationship to pupil) (relationship to pupil)

Address

Address

Address

 Tel.

Tel.

Tel.

Siblings: name/DOB/school/address (eldest first)

Health concerns

Who has responsibility on health issues?

Legal Status: S 20 S 31

(Voluntary Accommodation) Care Order (Interim/Full)

Date

Time in present placement

Contact arrangements with family (if appropriate include formal arrangements e.g. time/day, with whom)

Is anyone prohibited contact

What position should the school take if contacted by the above person? (e.g. contact social worker)

Section 2

Individual arrangements:

(Child and Adolescent mental health services, respite, home visits, Youth Offending Team, other appointments likely to occur in school time ...)

Transport arrangements including length of journey

Lunchtime/after school arrangements

 Is extra support available or required in school? (Please specify, e.g. EC, additional LSA

hours).

Audit Band:

SEN Code of Practice Stage:

Statemented Yes/No Date of last review?

Education Coordinator

Name Tel.

Address

When emergencies or problems occur at school, who is main point of contact outside school?

Who should be invited to parents' evenings?

Who funds school trips/books/food etc?

Who organises PE equipment/uniform?

Who signs the home/school agreement?

Does carer have a copy of homework timetable? Yes/No

If no, state action to be taken and by whom.

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Homework record book - who signs?

Name of secondary school

Has a place been applied for? Yes/No

Has the pupil visited the school? Yes/No

Will extra visits be arranged? Yes/No

Designated Teacher?

Who is the member of staff who coordinates transfers?

Is extra support needed for this transfer? Yes/No

Who will take action?

What will the action be?

Year 9

GCSE Options booklet - where is this to be sent?

Is an interview needed to discuss these? Yes/No

Personal learning plan - who will send a copy home?

Year 10

Details of work experience

Has the social worker signed the 'work experience agreement form'? Yes/No

Year 11

Has the student received careers advice at school? Yes/No

Name of the careers adviser.

Does the student have a clear idea of what they want to do post 16? Yes/No

(If yes, please give details)

If no, has a careers interview been arranged at the Careers Centre? Yes/No

Please give date.

Is there a record of the interview with the careers adviser and a plan of

action? Include the arrangements for the next appointment. Yes/No

If the student is planning to continue in post 16 education, has an

application form been submitted, if applicable? Yes/No

Who will take the student to visit the post 16 establishment?

If the plan is to start work, has an appropriate placement/training

scheme been identified? Yes/No

(If yes, please specify.)

By whom?

Who will take the student to visit the provider?

If there is no plan, what action is being taken? (e.g. referral to the Careers

Service Learning Gateway.

(The details of these targets should be held within standard plans such as an IEP, PSP and recommendations of the Statement of Special Educational Need.)

My actions will be:

Signed ...............................................................

Date ..................................................................