Primary PEP form

Name
Age
School
Year group
Date of my PEP meeting
PEP / Autumn term (PEP 1)

Spring term (PEP 2)

In school I like:
/ In school I do not like:
I am good at:
/ I would like to get better at:

I want help with:
/ Anything else I want to tell you about my work at school:
Out of school, I like doing:
When I grow up, I want to be:
Have I been bullied in the last 3 months? Yes No
If yes, what did I or an adult do about it?
Has the bullying stopped? Yes No

SECTION A – (DT to complete before the PEP)

School’s Contribution - Achievement and Attainment

Please fill in the EYFS and KS1 tables below for a KS1 pupil. Please also provide a print out of all available SIMS/other assessment data. Choose one of the following for the ‘Currently working at’ column in the KS1 and KS2 tables:

Working well below ARE* / WWB / Working above ARE* / WAb
Working below ARE* / WB / Working well above ARE* / WWAb
Working at ARE* / Wat

*Age related expectation

Please use one of the following for each early learning goal (ELG): 1 = Emerging, 2 = Expected, or

3 = Exceeding

EYFS
Previous outcomes / Communication & Language / Physical development / Personal, social and emotional development
ELG01 / ELG02 / ELG03 / ELG04 / ELG05 / ELG06 / ELG07 / ELG08
Literacy / Mathematics / Understanding the world / Expressive arts & design
ELG09 / ELG10 / ELG11 / ELG12 / ELG13 / ELG14 / ELG15 / ELG 16 / ELG17
Did the child achieve a good level of development overall? Yes ☐No☐
KEY STAGE 1 / End of previous key stage attainment / Currently working at / End of year target / On track to reach end of year expectations (Y/N)
Reading (ELG09)
Writing (ELG10)
Maths (ELG11 & 12)

Please fill in the table below for a KS2 pupil. Please also provide a print out of all available SIMS/other assessment data.

KEY STAGE 2 / End of previous key stage attainment / Currently working at / End of year target / On track to reach end of year expectations (Y/N)
Reading
Writing
Maths
Grammar, Punctuation & Spelling
Other assessment information e.g. phonics (Y1), reading age, standardised scores
Date / Assessment type / Outcome

2. Key Information

Attendance
Current attendance (%) / % / Number of unauthorised absences / Are there any concerns with punctuality? / Yes
No
Interventions actioned by the school to improve attendance/
punctuality
(if appropriate)
Attachments
Please attach print outs of the following / Attendance record
Last school report
Young person’s view form (p.2)?
Please attach print outs of the following
(if applicable) / IEP
Pastoral Support Plan
Behaviour Support Plan
Exclusion record
Other relevant plan or support

3. Special Education Needs and disabilities (only complete if applicable)

If the child has anything in the list below, please check the box and make sure a copy is with this plan (including a provision map if applicable):
School Support ☐ Transition Plan ☐
Individual Education Plan☐ Pupil Passport ☐
SEN Statement/EHCP☐ Pastoral Support Plan ☐
(if yes, please indicate the primary need below)
CI ☐ CL ☐ SEMH ☐ SPN ☐

CI – Communication and interaction CL – Cognition and learning SEMH – Social, emotional and mental health SPN – Sensory and/or physical needs

4. Current support (school based)

School based support / Details
EAL
Gifted and talented
School clubs & activities
Pastoral support (e.g. learning mentor)
Curriculum support (e.g. 1:1, small group, speech and language therapy) / Please specify time allocated and how often the support is received e.g. x 3 weekly (40 mins)
Any other support
e.g. counselling, occupational therapy

Current support (Out of school based support)

School based support / Details
Clubs and activities
Tuition
Other services (e.g. NSPCC, CAMHS)

5.Record of exclusions

Date started

/

Date ended

/

Type of exclusion

(fixed or permanent, internal, external)

/

Reason

If applicable, what provision has been made for exclusions over 6 days?

6) Key issues

(Please include comments on behaviour and any other barriers to learning)

Key needs

SECTION B- to be completed at the PEP

7. What changes or transitions do I have coming up that we need to plan for?

If applicable, has a secondary school application be made? Yes No
What is the transition plan?
Any concerns over transition?
(e.g. celebration assembly, 100% attendance, certificates etc )

8. My achievements this term

Previous PEP targets

Target / Target achieved / Give reasons
1 / not achieved
Some progress
achieved
2 / not achieved
Some progress
achieved
3 / not achieved
Some progress
achieved

New targets

Target / What will I do? / Who will help me?
/ When will I achieve this by? / How will I know I have achieved this target?
Example target
To make progress to the next reading level / I will read every day for 10 minutes.
I will go to the library every 3 weeks and choose a book to read.
I will play reading/literacy games on a computer at home once a week. / My teacher will give me a list of good reads.
My carer will read with me and help me complete my reading log. / By the end of the autumn term. / I will move to the next level of reading.
1
2
3

Actions

Action log (e.g. referrals to services such as Education Psychologist, speech and language)

Please follow up on the outcome of the action at the next PEP

Action to be taken / Lead person / By when / Outcome

Pupil Premium expenditure

Am I entitled to the Pupil Premium?Yes Not yet

Date used? / What on? / Impact?

If I am entitled to the Pupil Premium and it has not yet been used, please add this to my action plan.

We have all agreed this plan.

Designated teacher’s name: Signature:

Essential PEP information Record

Key People at this PEP meeting/contact details

Name / Title / Contact details
(If confidential please indicate)
/ X if need copy of PEP / Attended PEP
Carer / Email:
Contact number:
Parent/s / Email:
Contact number:
Social Worker / Email:
Contact number:
Designated teacher / Email:
Contact number:
Class teacher / Email:
Contact number:
Key Worker/Mentor / Email:
Contact number:
Virtual School Officer / Email:
Contact number:
Other / Email:
Contact number:
Date of next PEP meeting / Time / Venue

Previous school history

Social worker to complete before the meeting

Name and address of school

/

Date

started

/

Date left

/

Reason for leaving

Essential information

(Social worker to complete before the meeting)

Care status

Care Order
Interim Care Order
Section 20
Placement Order /

The contact arrangements (who, days, times)

Date of birth: / Date into care (most recent care episode):
Ethnicity: / CRS number:
UPN:
Who should be contacted in case of emergency? / Who will liaise with the school on a day-to-day basis?

Who will receive school information (e.g. school report, letters)?

/ Who will attend parents evening?
Is there anyone who should not have unsupervised contact and communication with the child? / How does the child travel to school?
If applicable, who is responsible for applying for primary/secondary school places? / If applicable, who will be responsible for visiting school open days?

1