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					                                                                                                                    Updated July 2007
                                                                                                        Please destroy previous copies
                                    CONFIDENTIAL                                                                              EXC1

                              CHILDREN’S SERVICES DEPARTMENT
                            EXCLUSION OF A PUPIL FROM SCHOOL
The Headteacher/Principal should complete this form and return it to the
Director for Children’s Services (FAO EOTAS Officer) for all types of exclusions


 Pupil details
 Name of pupil:………………………………………………………..                                                      M or F ………            DOB: ……………………
 School/College: …………………………………………………….…………………...                                                                  Year group: ……………….…

 Date pupil started at School/College: …………………………….…………………..                                                      Unique pupil no: ………….…



 Name of parent: ……………………………………………… Tel no: ………………… Mobile no: …………………….

 Address: ……………………………………………………………………………………………………………………….

 ……………………………………………………………………………………………… Post code: …………………….
 Children in Public Care (Children Act 1989) to comply with DfES statistical returns

 Is the pupil “Looked After”:     YES / NO                                                   Legal status:(please tick relevant status)

 Name of LEA responsible for the child’s care: ……………………………...                                            Accommodated

 Name of Carer: …………………………………………………………………                                                                Care Order

 Address of Carer: ………………………………………………………………                                                              Interim Care Order

 …………………………………………………………………………………….                                                                       Remand

 Post code: .………….. Tel no: ………… Mobile no: ……………………...                                                  Other (please state)


 Name of Social Worker: ..…………………………………………………………….                                                              Tel no:…………………….
 Exclusion details
    Type of Exclusion         Start date             End date               Number of days out
    Lunchtime                                                                                            A lunchtime exclusion is
    Fixed Period                                                                                         equivalent to ½ a school day
    Permanent

 Reason(s) for exclusion: (please refer to National Descriptors on this form) …………………………………………………….

 ………………………………………………………………………………………………… (please attach a copy of the letter)

 Does exclusion exceed 5 days YES / NO
 Arrangements for 6+ day provision made by the school
 Has this pupil been excluded previously this term? YES / NO        If yes, for how many school days …………….

 Has this pupil exceeded 16 school days this term? YES / NO

 Has a Governors Disciplinary meeting been convened for an exclusion that exceeds 16 school days or a permanent exclusion?               YES / NO

 Date of meeting (if known): ……………………………………….

 Will the pupil lose an opportunity to take a public examination as a result of his/her exclusion? YES / NO

 Please list pupil’s GCSE options, examinations boards and expected grades if he/she is in Year 10 or 11 and has been permanently excluded
 (continue on a separate piece of paper if necessary) ………………………………….
School information
Is there a school attendance problem with this pupil? YES / NO                          % attendance last term: ….. %

SEN Code of Practice Stage               None         Not known        School Action        School Action+      Statemented
(please circle)

IEP
Has this pupil got an IEP? YES / NO
Has the pupil been referred to the Educational Psychologist? YES / NO
If yes, when did the pupil see the Education Psychologist? ………………………………………………
Please attach IEP, copy of Statement and last Annual Review report, if appropriate, for fixed period exclusion(s) of 16
days or more in any one term of a permanent exclusion

PSP
Has a Pastoral Support Programme (PSP) commenced? YES / NO
Date commenced: …………………………………..                                        Date(s) reviewed: ……………………………..

Please attach PSP for fixed period exclusion(s) of 16 days or more in any one term or a permanent exclusion
Please indicate if any of the following agencies are involved with the pupil or his/her family
Education           Social Services Child and            Police              Youth                            Other
Welfare Service                        Family Care                           Offending Team                   (please state)

   YES / NO           YES / NO          YES / NO           YES / NO          YES / NO          YES / NO
Please describe the level of involvement (continue overleaf as necessary)
………………………………………..
ETHNIC BACKGROUND INFORMATION
The DfES requires schools/colleges to collect information on the ethnic background of pupils/students

White                                     Asian or Asian British                  Any other ethnic background
 British                                  Indian                                 Any other ethnic background
 Irish                                    Pakistani                                - Afghan
 Traveller of Irish heritage              Bangladeshi                              - Arab other
 Gypsy/Roma                               Any other Asian background               - Egyptian
 Any other White background                  - Nepali                               - Filipino
   - Greek                                    - Other Asian                          - Iranian
   - Kosovan                                                                         - Iraqi
   - Turksih                              Black or Black British                     - Japanese
   - White Eastern European                Caribbean                                - Korean
   - White Western European                African                                  - Kurdish
   - White other                           Any other Black background               - Latin/South/Central American
                                                                                     - Lebanese
Mixed                                     Chinese                                    - Libyan
 White and Black Caribbean                Chinese                                  - Malay
 White and Black African                                                            - Thai
 White and Asian                                                                    - Any other ethnic group
 Any other mixed background

Signature of Headteacher / Principal ……………………………………………….. Date:…………………

                          Please complete EXC2 when pupil returns to school
Notes

1.      A Headteacher must make suitable full-time provision available to the excluded pupil
        from the sixth day of any period of fixed period exclusion of six days or longer, and if she
        or she wishes, make provision available to the pupil at an earlier day than the sixth day.
        Provision should normally be off-site, but a school may make provision on-site where
        arrangements for shared on-site provision have been made jointly with the Governing
        Body of at least one other school and is available to excluded pupils from that or those
        other schools.
2.      The actual date of re-admission must be notified to the EOTAS Officer by completing
        Form EXC2.
3.      Please notify the EOTAS Officer of all fixed period exclusions by using the EXC1
        attaching a copy of the letter sent to the parent(s) / guardian(s) / carer(s).
        For a permanent exclusion please notify the exclusion officer on the same day or at the
        earliest possible opportunity.
        Please send all paperwork relating to a permanent exclusion by first class mail.
4.      In the case of a permanent exclusion, a fixed period exclusion of 16 school days or more
        (total or aggregate in any one term) or any fixed period exclusion where the pupil will
        miss the opportunity to take public examinations please contact the EOTAS Officer:
        a)     of the likely date when the Governors Discipline Committee will meet to consider
               the exclusion;
        b)     to check the availability of an LEA Officer to attend the meeting;
        c)     if the parent(s) / guardian(s) / carer(s) intend to make written representations;
        d)     if the parent(s) / guardian(s) / carer(s) intend to be present at the Governors
               Discipline Committee meeting and if they will be accompanied by a
               representative (legal or otherwise).
               Please provide the following information for the Governors Discipline
                     Committee:
               A full report on the pupil including:
               Academic Achievement Record;
               Pastoral Support Programme (PSP);
               Individual Education Plan (IEP), if Statemented, plus a copy of the Statement;
               Attendance Record;
               Headteacher’s Report;
               Plus any other relevant information relating to the incident eg Witness/Victim
                      statements.
               All information should reach the Governors and the LEA at least 7 days
               before the meeting
               NB:
        1.     For pupils who are statemented and at risk of permanent or a lengthy fixed term
               exclusion an interim annual review should take place, ideally before the exclusion
               takes place. If a pupil is going through the assessment process the school should
               seek advice from the LEA.
        2.     Reports or incident sheets containing the names of other pupils involved
                      in incidents with the excluded pupil should be anonymised.
                            National standard list of reasons for exclusions
This list provides descriptors of reasons for exclusions. The 12 categories should cover the main reasons
for exclusions and the ‘other’ category should be used sparingly. The further detail suggesting what the
descriptors cover should be used as a guide and this list is not intended to be used as a tick-list for
exclusions.

 Physical assault against pupil                                  Physical assault against adult
 Includes:                                                       Includes:
 Fighting                                                        Violent behaviour
 Violent behaviour                                               Wounding
 Wounding                                                        Obstruction and jostling
 Obstruction and jostling
                                                                 Bullying
 Verbal abuse/threatening behaviour against pupil and            Includes:
 Verbal abuse/threatening behaviour against adult                Verbal bullying
 Includes:                                                       Physical bullying
 Threatened violence                                             Homophobic bullying
 Aggressive behaviour                                            Racist bullying
 Swearing
 Homophobic abuse and harassment                                 Sexual misconduct
 Verbal intimidation                                             Includes:
 Carrying an offensive weapon                                    Sexual abuse
                                                                 Sexual assault
 Racist abuse                                                    Sexual harassment
 Includes:                                                       Lewd behaviour
 Racist taunting and harassment                                  Sexual bullying
 Derogatory racist statements                                    Sexual graffiti
 Swearing that can be attributed to racist characteristics
 Racist bullying
 Racist graffiti
                                                                 Theft
 Drug and alcohol related                                        Includes:
 Includes:                                                       Stealing school property
 Possession of illegal drugs                                     Stealing personal property (pupil or
 Inappropriate use of prescribed drugs                           adult)
 Drug dealing                                                    Stealing from local shops on a school
 Smoking                                                         outing
 Alcohol abuse                                                   Selling and dealing in stolen property
 Substance abuse
 Damage
 Includes damage to school or personal property belonging to any member of the school
 community:
 Vandalism / Arson / Graffiti
 Persistent disruptive behaviour
 Includes:
 Challenging behaviour / Disobedience / Persistent violation of school rules
 Other
 Includes:
 Incidents that are not covered by the categories above, but this category should be used sparingly.

				
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posted:10/23/2012
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