Education Attendance Service
CHILDREN MISSING EDUCATION REFERRAL FORM
[Including all pupils admitted or removed by your school]
ALL PUPILS REMOVED/ADMITTED MUST BE REFERRED WITHIN 5 DAYS OF THE EVENT
Child Missing Education: ☐ Pupil removed from roll: ☐
Pupil withdrawn to Electively Home Educate: ☐ Pupil admitted to the roll: ☐
[Ensure EHE procedure is followed]
NAME OF CHILD: Click here to enter text.
OTHER NAMES BY WHICH CHILD IS KNOWN:Click here to enter text.
DOB: Click here to enter a date.
ETHNICITY & RELIGION: Click here to enter text.
SEX: Click here to enter text.
UPN: Click here to enter text.
PARENTS/CARERS NAMES: Click here to enter text.
PARENTS/CARERS CONTACT NOS: Click here to enter text.
LAC & Referred to LACESS: Choose an item.
LAST KNOWN ADDRESS: Click here to enter text.
NEW ADDRESS: Click here to enter text.
EMAIL ADDRESS: Click here to enter text.
LAST SCHOOL/PROVISION ATTENDED: Click here to enter text.
DATE LAST ATTENDED (IF KNOWN): Click here to enter a date.
DOES THE CHILD HAVE SEN SUPPORT? Choose an item.
DOES THE CHILD HAVE A STATEMENT OR EDUCATION HEALTH & CARE PLAN?
Choose an item.
HAS A REFERRAL BEEN MADE TO THE EDUCATION ATTENDANCE SERVICE?
Choose an item.
IF YES, NAME OF EWO: Click here to enter text.
IS THE CHILD SUBJECT TO ANY OF THE FOLLOWING INTEVENTIONS: Choose an item.
IF YES, HAS SOCIAL CARE/SUPPORT WORKER BEEN INFORMED OF THE FAMILY’S DISAPPEARANCE? Choose an item.
CONTACT DETAILS OF SUPPORT WORKER: Click here to enter text.
IS THE CHILD ENTITLED TO FSM: Choose an item.
DETAILS OF CHILD’S DR/SURGERY: Click here to enter text.
DESCRIPTION OF ENQUIRIES MADE AND RELEVANT INFORMATION (pleaseinclude details of other family members with contact details if known, andrefer to schools check list when completing this section):
Click here to enter text.
REASON FOR REMOVAL FROM ROLL: Click here to enter text.
DATE REMOVED: Click here to enter text.
NEW SCHOOL: Click here to enter text.
START DATE: Click here to enter a date.
HAS IT BEEN CONFIRMED THAT PUPIL STARTED: Choose an item.
NAME OF PERSON COMPLETING FORM: Click here to enter text.
ACENCY/SCHOOL: Click here to enter text.
ROLE WITHIN SCHOOL / AGENCY: Click here to enter text.
DATE: Click here to enter a date.
E-MAIL AND CONTACT NO: Click here to enter text.
ENSURE SECURE TRANSFER OF THIS INFORMATION, PLEASE RETURN BY EMAIL ONLY
Maryanne Corringham
Children Missing Education Officer
, Tel: 01473 265224 August 2016