Please attach the attendance certificate: 4.2 Fixed Term Exclusions – Date Reason No. of ½ school days lost 5.1 Academic details – Please attach the pupil’s most recent school report. If not available, please provide the pupil’s latest levels. 6.1 Risk assessment – Please tick the box if a risk assessment has been previously carried out. Please attach. 7.1 - Declaration Has the referral been Yes/No Has this referral been Yes/No discussed and agreed with discussed and agreed parents/carer? with Signature of Date: Headteacher/Head of Service: Please note that home tuition is not guaranteed. This should be made clear to parents/carers. Please fully complete the referral form and return VIA SECURE EMAIL with all supporting documents to and
Please attach the attendance certificate: 4.2 – Fixed Term Exclusions Date Reason No. of ½ school days lost 5.1 – Academic details Please attach the pupil’s most recent school report. If not available, please provide the pupil’s latest levels. 6.1 – Risk assessment Please tick the box if a risk assessment has been previously carried out. Please attach. 7.1 - Declaration Has the referral been discussed and agreed with parents/carer? Yes/No Has this referral been discussed and agreed with Yes/No Signature of Headteacher/Head of Service: Date: Please note that home tuition is not guaranteed. This should be made clear to parents/carers. Please fully complete the referral form and return VIA SECURE EMAIL with all supporting documents to and