Inclusion Panel Report

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Inclusion Panel Report

Referral Details

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Receiving School

School Name:

Name (Head):

Telephone:

Email:

Summary of Behaviour Leading to Managed Transfer

Negative: * This field is required

Positives: * This field is required

Attendance % * This field is required

Punctuality % * This field is required

Why should this pupil be Managed Moved? * This field is required

Family Details

Mother/Carer

Title:

First Name(s):

Last Name:

Parental Responsibility

Address:

Postcode:

Home Phone No:

Mobile Phone No:

Work Phone No:

Father/Carer

Title:

First Name(s):

Last Name:

Parental Responsibility

Address:

Postcode:

Home Phone No:

Mobile Phone No:

Work Phone No:

Exclusion Details

Fixed term exclusion details:

Support offered to receiving school should a managed move be agreed:

Does the child receive free school meals?

Yes

Is the child at Child In Need or Child Protection?

Yes

Has the child previously been at Child In Need or Child Protection?

Yes

Outside agencies involvement:

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