Please complete all fields marked (*)
Date Of Birth
Name Of Parent/Carer
Parent/Carer's Phone Number
Is the student LAC?
If yes please state the care authority
Unique pupil number
Pupil's School Year
Statement of SEND
Reason for Referral
History of harm to self/others
History of sexualised behaviour
History of criminal behaviour
History of drug/alcohol/solvent abuse
Is the student subject to any orders?
Is the School aware of any police involvement?
Are there any contributing factors in or outside of school that might contribute to the pupil's difficulties?
Attendance for this term
Attendance for this Year
Are there any factors that affect the pupils attendance?
Has any action been taken regarding attendance?
Please give any dates of letters sent
Please give details of support offered to the student (type of support, aim, outcome)
External support (inc CAMHS, college placements, ARTS, social services etc)
Is the extername support ongoing?
What type of learner is the student?
Please detail what time of lessons the pupil enjoys and any areas of the curriculum they find challenging
Please comment on their social development
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