NOTIFICATION OF PERMANENT EXCLUSION Inclusion@staffordshire.gov.uk To be completed and returned on the day of permanent exclusion to: (This will enable the LA to provide the Alternative Provision from Day 6 from the permanent exclusion) Name of School Dfe No Contact Person/ Contact Tel Position Number/ Email: Please specify with x if your school is:- Academy Maintained School Special School PRU Other (please specify) Pupil Details Surname First Name Middle Name: Address Postcode Telephone No UPN Gender (please Male Female specify with x) Date of Birth --/--/---- NCY Group Key Stage Parent / Guardian Carer Details Parent Guardian (e.g Carer Parent / Guardian / Carer Details (Please – specify with x) Grandparents) Title Mr/ Mrs / Miss /Ms Surname First name Full Postal Address (if different from above) Are there any issues with Yes No home visiting this family Please provide any relevant details. that you are aware of. Please specify details of other person with Parent responsibility (with address if not same as above). Are there any known risks to the family preventing us from confirming this permanent exclusion to the other person with parental responsibility Yes No Parent / Guardian / Carer Details (Please Parent Guardian (e.g Carer – specify with x) Grandparents) Mr/ Mrs / Miss /Ms Title Surname First name Full Postal Address (if different from above)
NOTIFICATION OF PERMANENT EXCLUSION To be completed and returned on the day of permanent exclusion to: Inclusion@staffordshire.gov.uk (This will enable the LA to provide the Alternative Provision from Day 6 from the permanent exclusion) Name of School Dfe No Contact Person/ Position Contact Tel Number/ Email: Please specify with x if your school is:- Academy Maintained School Special School PRU Other (please specify) Pupil Details Surname First Name Middle Name: Address Postcode Telephone No UPN Gender (please specify with x) Male Female Date of Birth --/--/---- NCY Group Key Stage Parent / Guardian Carer Details Parent / Guardian / Carer Details – (Please specify with x) Parent Guardian (e.g Grandparents) Carer Title Mr/ Mrs / Miss /Ms Surname First name Full Postal Address (if different from above) Are there any issues with home visiting this family that you are aware of. Yes No Please provide any relevant details. Please specify details of other person with Parent responsibility (with address if not same as above). Are there any known risks to the family preventing us from confirming this permanent exclusion to the other person with parental responsibility Yes No Parent / Guardian / Carer Details – (Please specify with x) Parent Guardian (e.g Grandparents) Carer Title Mr/ Mrs / Miss /Ms Surname First name Full Postal Address (if different from above)
notification-of-permanent-exclusion-2018_2_.docx