• 1Pupil details
• 2Parent/guardian details
• 3School details
• 4Timetable details
• 5Summary

Progress

Pupil details

Details of pupil to be placed on reduced timetable

Pupil first name:

Pupil last name:

Pupil known as:

Date of birth

UPN (this must be 13 characters long):

this must be 13 characters long

Gender: (optional)

Ethnicity: -- Please Select -- White - British White - Irish White - Traveller of Irish Heritage White - Gypsy/Roma White - Any other white background Mixed - White and Black Carribean Mixed - White and Black African Mixed - White and Asian Mixed - Any other mixed background Asian/Asian British - Indian Asian/Asian British - Pakistani Asian/Asian British - Bangladeshi Asian/Asian British - Any other Chinese Any Other Ethnic Group Refused Not known at this stage Asian background Black/Black British - African Black/Black British - Caribbean Black/Black British - Any other Black background

Year group:

SEN level:

SEN Support

EHCP

N/A

Type of SEN:

Is the child in receipt of high needs funding?

Yes

No

Is the child looked after?

Yes

No

Reduced timetable agreed by the Virtual Headteacher

Yes

No

Is the child subject to child protection plan?

Yes

No

Has the reduced timetable been discussed with the child's social worker

Yes

No

Is the child in need?

Yes

No

Has the reduced timetable been discussed with the child's social worker

Yes

No

No information is required, please proceed to the next page.

Parent/guardian details

Details of responsible parent or guardian

Parent / guardian name:

Relationship to pupil:

Address:

Postcode

Find Address

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Select Address -- Please select --

 

Address line 1

Address line 2 (optional)

City

Postcode

Clear postcode/address

Use the Lookup Postcode button to find the address.

If you cannot find the address, please enter it manually

Contact number:

Has the parent formally agreed to the reduced timetable?

Yes

No

No information is required, please proceed to the next page.

School details

Details of school the pupil attends

School name:

School type:

Primary School

Secondary School

Special School

DfE number:

School provision:

School contact name:

School contact telephone number:

School contact email address:

Confirm school email address:

No information is required, please proceed to the next page.

Timetable details

Details and duration of reduced timetable

Reason for the reduced timetable:

Start date of reduced timetable:

dd/mm/yyyy

End date of reduced timetable:

dd/mm/yyyy

Total days on reduced timetable:

The number of weeks the pupil will be on a reduced timetable:

Pupils cannot be on a RTT for more than 8 weeks unless the RTT case has been reviewed by the Local Authority Children Out of Provision Panel and deemed as an exception

-- Please Select -- 1 Week 2 Weeks 3 Weeks 4 Weeks 5 Weeks 6 Weeks 7 Weeks 8 Weeks

Number of hours of educational provision offered per week to the pupil:

Start date of Alternative Provision, if applicable: (optional)

dd/mm/yyyy

Reduced Timetable agreed by SEN team:

(if applicable)

Yes

No

N/A

Name of SEN Caseworker:

Review date:

dd/mm/yyyy

Any additional comments: (optional)

Upload the completed checklist for reduced timetables: (optional)

No information is required, please proceed to the next page.

Before you submit this form please review your answers below. If you need to change anything, use the 'previous' button on the bottom left to go back to a section. Then submit the form by selecting the 'Submit button' at the bottom of this page

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