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					Entered on ONE Online on day of exclusion Children & Young People’s Service

(please state Yes when entered)

NOTIFICATION OF PERMANENT EXCLUSION
May 2009
Please complete all sections of this form in full within one school day of exclusion and EMAIL, together with a copy of the Head Teacher’s notification letter to parents to:
cromwell.county@cec.northants-ecl.gov.uk Mrs Bobbie Kelly (Headteacher) Complementary Education County Office Cromwell Centre Poole Street Northampton NN1 3EX (Tel: 01604 239734/Fax: 01604 626950) and copy to BACIN ASWhite@northamptonshire.gov.uk (Tel: 01604 857386/Fax: 01604 857394)

The information required is important in ensuring that an appropriate placement for the young person is made within 6 days of the permanent exclusion.  This form should be EMAILED to Complementary Education within one school day of exclusion along with a copy of the Head Teacher’s notification letter to parents.  Please transfer SIMS CTF via AVCO to 9281100.  Copies of related reports (IEPs, PSPs etc) and the pupil file will be collected from the school by Complementary Education following the appeal timeline or before if they receive written notification of parents/carers decision not to appeal.
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NOTIFICATION OF PERMANENT EXCLUSION
Name of pupil School Name of parent(s)/guardian/carer Address Tel no Additional names/addresses of other adults with parental responsibility Emergency contact no DoB NC year UPN Gende r

Parent(s)/guardian/carer informed? (Yes/No) Parent(s)/guardian/carer response?

Language spoken at home Details of family background information:

In public care? (Yes/No)

If yes, name of Local Authority

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NOTIFICATION OF PERMANENT EXCLUSION
DATE ON WHICH PUPIL WAS EXCLUDED PERMANENTLY Total (school days) of any exclusions: Current term days Previous term days Next preceding term days

Details of any other permanent exclusions:

Schools attended (last 3 years):

Attendance record over last 2 terms: Present Approved educational activity Authorised absent Unauthorised absent Free school meals (Yes/No) Yes/No Statement of SEN Statutory Assessment under way Date

Name/role of school contact EWO name Last date of attendance

RSA submitted School Action School Action Plus

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NOTIFICATION OF PERMANENT EXCLUSION
Name of pupil 1 Details of incident resulting in exclusion: Name of school

2 Details of behavioural history, including previous warnings, fixed-term exclusions and other disciplinary measures:

3 Any strategies or arrangements employed to manage the pupil‟s behaviour:

4 Please list student‟s strengths:

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NOTIFICATION OF PERMANENT EXCLUSION
5 Please list current concerns re student behaviour:

6 Please highlight any strategies that are effective with this young person:

7 Details of any Special Educational Needs the pupil may have:

8 Details of parental involvement (eg letters home, meetings etc):

Has parent been involved in: Pastoral Support Programme Parenting Contract

Yes/No Parenting Order Common Assessment Framework

Yes/No

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CYPS/PEX/Feb 2009

NOTIFICATION OF PERMANENT EXCLUSION
9 Maths Science English Geography History Modern Languages Music Art Expressive Arts PE ICT Child Care Any other subjects: Academic information Current Performance A-F Ability A-F Key Stage/ level Current predicted grade Entered for exams (Yes/No) Name of exam board

10 Current timetable:

Full time (Yes/No)

Part time (Yes/No)

Reading Age

11 Vocational studies - please specify:

12 Details of college placement:

13 Details of work experience placement:

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NOTIFICATION OF PERMANENT EXCLUSION
14 Any other information which may be helpful:

15 Asthma Eczema Hay Fever Allergies

Medical Conditions

Any other information

Yes/No

Hearing loss Visual impairment Others - please state:

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NOTIFICATION OF PERMANENT EXCLUSION
16 Contact with other Agencies: Agency Child and Adolescent Mental Health Service Children‟s Services (Social Services) Connexions CYPS BACIN/Additional Needs Team Education Welfare Service Educational Psychologist Health Service Race Equality Team Virtual School (Children in Care) Youth Offending Service General Practitioner Asylum Team Name/Team(s) Dates and duration of involvement (approx)

Please state whether you would be prepared to re-admit this pupil following external interventions (Yes/No)
Name of person responsible for collection and transfer of all coursework and PF (Progress File) If this pupil has been the subject of a common assessment please email copy Signature/name of Headteacher Date

Date file can be collected from school (post appeal timeline)

Date

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NOTIFICATION OF PERMANENT EXCLUSION NATIONAL STANDARD LIST OF REASONS FOR EXCLUSIONS This list provides descriptors 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 is not intended to be used as a tick list for exclusions. In reaching a decision on whether to exclude, Headteachers need to refer to the Department‟s guidance published in October 2004, entitled “Improving Behaviour and Attendance: Guidance on Exclusion from School and Pupil Referral Units”. (DfES) Please select ‘Yes’ from dropdown box if applicable
PHYSICAL ASSAULT AGAINST PUPIL (PP) Includes:  Fighting  Violent behaviour  Wounding  Obstruction and jostling PHYSICAL ASSAULT AGAINST ADULT (PA) Includes:  Violent behaviour  Wounding  Obstruction and jostling VERBAL ABUSE/THREATENING BEHAVIOUR AGAINST PUPIL (VP) Includes:  Threatened violence  Aggressive behaviour  Swearing  Homophobic abuse and harassment  Verbal intimidation  Carrying an offensive weapon VERBAL ABUSE/THREATENING BEHAVIOUR AGAINST ADULT (VA) Includes:  Threatened violence  Aggressive behaviour  Swearing  Homophobic abuse and harassment  Verbal intimidation  Carrying an offensive weapon BULLYING (BU) Includes:  Verbal  Physical  Homophobic bullying RACIST ABUSE (RA) Includes:  Racist taunting and harassment  Derogatory racist statements  Swearing that can be attributed to racist characteristics  Racist bullying  Racist graffiti SEXUAL MISCONDUCT (SM) Includes:  Sexual abuse  Sexual assault  Sexual harassment  Lewd behaviour  Sexual bullying  Sexual graffiti DRUG AND ALCOHOL RELATED (DA) Includes:  Possession of illegal drugs  Inappropriate use of prescribed drugs  Drug dealing  Smoking  Alcohol abuse  Substance abuse DAMAGE (DM) Includes to school or personal property:  Vandalism  Arson  Graffiti THEFT (TH) Includes:  Stealing school property  Stealing personal property (pupil/adult)  Stealing from local shops on a school outing  Selling and dealing in stolen property PERSISTENT DISRUPTIVE BEHAVIOUR (DB) Includes:  Challenging behaviour  Disobedience  Persistent violation of school rules OTHER (OT) Includes: Incidents which are not covered by the categories above but this category should used sparingly

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NOTIFICATION OF PERMANENT EXCLUSION

ETHNIC MONITORING Please select ‘Yes’ from dropdown box if applicable
WHITE British Irish Traveller - Irish Heritage Gypsy/Roma Any other white background MIXED White/Black Caribbean White/Black African White/Asian Any other mixed background ASIAN OR ASIAN BRITISH Indian Pakistani Bangladeshi Any other Asian background BLACK OR BLACK BRITISH Black Caribbean Somali Other Black African Any other Black background CHINESE Chinese OTHER ETHNIC GROUP Vietnamese Other ethnic group Refused Information not obtained OVIE OOEG REFU NOBT CHNE BCRB BSOM BAOF BOTH AIND APKN ABAN AOTH MWBC MWBA MWAS MOTH WBRI WIRI WIRT WROM WOTH

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