Early Years Personal Education Plan

Name of Child: / Child’s surname:
Known as: / Child’s address:
Date of birth: / Sex: / Male / Female
Nationality: / Religion:
First language: / Any other language spoken:
Admission date: / Key person in setting:
Session / Monday / Tuesday / Wednesday / Thursday / Friday
Full day
AM
PM
Early Years Provider: / Last Ofsted Grade:Date:
Other Early Years setting/school child attends:
Contact with child
Title / Name and contact details / Relationship to the child / Denied all contact / Denied written contact / Denied personal contact / Other comments
Key Adults
Social worker: / Contact details:
Child in Need Worker / Contact details:
Children Centre Worker:: / Contact details:
Any other agencies: / Contact details:
Care status:
Is there are a Care Plan in place?
Date of review?
PEPs in place? If so date of completion:
Special Educational Needs? / Yes / No / Please circle attached: MAO/MSP/EHCP
BAND 1 / Yes / No / BAND 3 / Yes / No
BAND 2 / Yes / No / BAND 4 / Yes / No
PEP completed by: dd/mm/year
Staff name:
Position: / Signature: / Date:
Parent / Carer: / Signature: / Date:
Parent / Carer: / Signature: / Date:
Social Worker: / Signature: / Date:
Foster Carer: / Signature: / Date:
Attachments to PEP include:
Please use templates provided or use settings own documentation / Date completed
Baseline Assessment / Yes / No
Two Year Progress Check / Yes / No
Progress Summary / Yes / No
My Agreed Outcomes (MAO /MSP / EHCP) / Yes / No

EYLW June 20161

PROGRESS SUMMARY – PRIME AREAS OF LEARNING

EYLW June 20161

PROGRESS SUMMARY – SPECIFIC AREAS OF LEARNING

EYLW June 20161

______helped me

EYLW June 20161

My Agreed Outcomes
My name:
My date of birth: / Long Term Outcome number: LT0......
Area of development:
By...... I will be able to:
My Early Years Setting(s):
My key people:
Outcomes agreed and signed by:
Parents/carers Date:
SENCO Date:
Short Term Outcome number: / What am I going to do/learn or what do I want to achieve?
I I will be able to: / By when?

What or who will I need to help me? /
Intended Outcome... what difference will this make? /
Who will monitor this and how?
What resources will I need? Exactly what will adults do and say to help me to achieve my outcome? / How will I know when I have been successful?
I will be able to... / How will progress be recorded and who will record and evaluate it?
How did I get on?
Outcome: I will be able to...
Date: / How did I get on?
Did I do it by myself? What prompts did I need?
What did you do to help me? / Date: / How did I get on?
Did I do it by myself? What prompts did I need?
What did you do to help me?
Was this outcome achievable for me? Can I do this in lots of different situations now? What might be the next step?

EYLW June 20161

Transition to School:To be completed where appropriate
Name
DOB / Early Years Setting
Proposed transfer to: / Proposed date of entry
Ofsted Rating of proposed School: Outstanding / Good
If school currently holds Ofsted Inadequate or Requiring Improvement judgement please state reason for proposed school;
Transition Planning
Meeting Date
Meeting Attendees Name
School Representative
Designated Worker (Pre School)
Carer
Parent
Social Worker
Designated Teacher for CLA
Others
Actions required to support a successful transition
Action / By whom / Target Date

Funding Accessed

Funding / Yes / No
Two Year Old Funding
Free Early Education Funding (3/4 years)
Amount / Funding Used For / Impact?
Early Years Pupil Premium (3+ years)
Deprivation Supplement
Inclusion Funding
Other
Total Funding

Planned use of Early Years Pupil Premium

Planned use and timescale / Cost
£ / Intended Outcomes

EYLW June 20161

Personal Education Plan

Action Plan for Name:

Completed at PEP Meeting Date:

Termly PEP Review Date:

Focus of Intervention / Agreed Targets / Actions/Timescale / Lead Person / Date to be completed / Impact / Progress
Actions from previous PEP
New Actions

Please forward completed PEP by Post to: Danesgate Community, Fulford Cross, York YO10 4PB

Or secure email to: Sarah Clarke Head teacher CYC Virtual School

l 01904 642611 ext 226

EYLW June 201610