Initial Pupil Information Form (Please Complete All Sections Fully to Prevent Delays)

Initial Pupil Information Form(please complete all sections fully to prevent delays)

Date sent / Date Received
(office use only) / Gender / M / F
Name / DOB / Year Group
Parent(s)/Carers / Parental Responsibility / Yes / No
/ Ethnicity
Religion
Address / CAF / Yes / No
LAC / Yes / No
Telephone No(s) / FSM / Yes / No
PSP / Yes / No
SEN / SA+ / Statement / Awaiting
/ Health & Safety Issues
/ Yes / No
… if yes please attach Risk Assessment
NC level / English
Maths
Science
/ Predicted Key Stage Targets / English
Maths
Science
/ Attendance
% this academic year / Present
Authorised Abs
Unauthorised Abs
CATS / WRAT
VRQ / Verbal / Non Verbal / Quantitative / MeanSAS / Reading Age / Spelling Age
School / School Contact / Position
BHLP (name)
Multi-Agency Working and Supporting Documents
Agency / Service involved / Name of professional / Contact details / Documents / reports / Attached
Request submitted by: / Print / Sign / Date
Headteacher
Why are you referring this pupil to CTAPS?
What measures have the school already taken to support this pupil?
How successful have they been?
How many days of exclusion has this pupil had this year? / Please note that the referring school may be required to provide work for independent study in Maths, English and Science for this pupil to complete in Centre
Have you informed the parents / carers that you are making this referral? / Yes / No
/ If yes have parents agreed to this placement? / Yes / No
Have the pupils’ needs been discussed with a PRS Manager? / Yes / No
Are there any safeguarding issues that the PRS need be aware of? / Yes / No
If yes please specify separately
Please add additional information here, such as:

college placements
work experience
exam requirements etc

Data Protection Act. This information is being collected for the purpose of determining the educational needs of the named pupil, but may also be shared with other relevant professionals to inform their work. The information collected may also be used for the wider purpose of providing anonymised statistical data to assist with monitoring of provision and/or determining areas of need in order to target future resources. For further information please contact Michael Buist, Headteacher on01242 581519.

Please return this form to:

Michael Buist, HeadteacherCheltenham & Tewkesbury APS, St Georges Centre, Alstone Lane, Cheltenham, Gloucestershire GL51 8HH

 (E-mail)

 01242 581519