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Elective Home Education School Exit Information
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Elective Home Education School Exit Information
This form should be completed and returned to Elective Home Education (EHE) with a copy of the withdrawal/de-registration letter from parents, an attendance certificate and a copy of the last report.
The purpose of this form is to gather information on students being de-registered from the school roll to be educated at home. Please complete as fully as possible.
Child details
Name of child
First name
Last name
Date of birth
NCY
Is this child a carer?
Yes
No
Address
Address Line 1
Address Line 2
City
County
Postcode
Country
Name of parents/carers with parental responsibility
Telephone number/s
Mobile/s
Parent/s email address
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School Details
Name of school
Names of school aged siblings if known
Date school received withdrawal letter from parents/carers
Attendance
Date last attended school
Have you discussed home education with the family?
Yes
No
Did anything happen in school which may have led the parents to take this decision
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In your opinion what is the main reason the parent is withdrawing their child to home educate them?
Please select
Problems with SEN provision
No satisfactory school place
Dissatisfaction with school provision
School Refuser
Permanent exclusion
Risk of exclusion
Attendance/at risk of prosecution
Referral to SSU
Racism/Homophobia bullying
Gifted/Talented
Religious Beliefs
Philosophical
Bullying
Medical needs of parent
Lifestyle/cultural
Physical medical needs of child
Social, emotional or mental health of the child
Requested or suggested by school
COVID-19
Does the child have special educational needs/support in school?
EHCNA/EHCP
SEN support
None
Please provide details of any support provided
If EHCP name of SEND keyworker
Last EHCP review date
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When was the child’s most recent school assessment and what levels did they attain?
Please provide a brief description of learning concerns/positives
Has the child had any fixed term exclusions in the current academic year?
Yes
No
If so, please attach details
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Has early help been considered or completed?
Yes
No
If yes please attach a copy
Is there a safeguarding file?
Yes
No
Has this child been on Child Protection in the past or currently on CP?
Yes
No
Is this a Child in Need?
Yes
No
Name of social worker
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Are any other agencies involved with the family and if so, who is involved?
Please provide details of any safeguarding concerns you may have or any other relevant information
Does the school have any concerns about the parents’ ability to provide a suitable education for this child? If yes, please give details
Do you know of any reasons why this family should not be visited by a lone member of staff?
Has the school made an offer of support to the child or parent e.g. examinations/learning resources? If yes, please specify
Any other comments we should be aware of
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Please attach a signed copy of the de-registration letter from parents with PR
Please attach an attendance certificate
Please attach a copy of the last attainment report
Is there a safeguarding file?
Yes
No
If yes, please attach a copy
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Next Page
Signed
Date
Position in school
Contact Telephone Number(s)
I confirm that the information provided on this form is accurate
Signature of Headteacher
Date
Previous Page
Submit
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