Notification of removal from roll

This form is used to inform the Local Authority that a student has been removed from your school roll. The destination of that child is known and the appropriate tracking of this child has been completed. This includes children moving out of the Country – proof of travel has been seen and an address has been obtained. This is in line with CME Guidelines 2016

Please also be aware that this does not replace safeguarding procedures. Should you have concerns about a child then you must report these to the first contact team professionals line immediately on 01332 641172 and also the police on 101.

The fields marked with an asterisk (*) are required fields. All the information you enter will be submitted securely.

Referrer's details

* School name

* Your name

* Your email address

* Confirm Your email address

Email addresses do not match.

* Has a home visit been completed to confirm they are no longer at the property?

Yes
No

* Date home visit completed?

* Outcome of home visit e.g. was the property empty?

Pupil details

* Full name

* Date of birth

* UPN

* Are there any siblings in your school who have also left?

Please select No Yes

* Sibling(s) details (include name(s), Date(s) of birth and UPN(s)

* Regulation removed from roll

Please select 1 - School attendance order 2 - In year transfer 3 - Successful managed move 5 - Moved out of area – new address and school confirmed 7 - Medical tuition – confirmed as unfit for school before end of compulsory school age 9 - Custodial sentence/prison -four months and pupil will not return 10 - Pupil has died 11 - Sixth form/ Year 11 ends before June 12 - Attends an Independent school 13 - Permanent exclusion

* Date removed from roll

* Is the child nusery-aged?

Please select No Yes

* Has the child moved to another nursery?

Please select No Yes

* Name of new nursery

* Has child moved schools within Derby city?

Please select No Yes

* Name of new school

* Date on roll

* Gender

Please select Male Female Other

* Has left the UK?

Please select No Yes

* Compulsory school age 5+?

Please select No Yes

* Ethnicity

Please select White British White Irish Other White background Dual Heritage - White and Black Caribbean Dual Heritage - White and Black African Dual Heritage -White and Asian Dual Heritage - Other Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Other Black or Black British - Caribbean Black or Black British - African Black or Black British - Other Chinese Roma Unknown Other

* SEN status

* Has the child a disability?

No
Yes

* Disability details

* CP status

Please select Current Historical None

* CP details

* Full name of parent/carer

* Telephone number

* Address

* New address

* Has the appropriate removal from roll letter been sent?

No
Yes

* Have you confirmed that they are no longer at the property?

No
Yes

Date living at new address

Date of start at new school

Are there any other agencies involved?

Social care
YOS
MAT
EYS
Health concerns
SEN
Other

* Agency details

School name in new local authority/new local authority admissions department

* School name/admissions

* Contact(s) made

Phone call
Email
Admissions contact

* Details of contact(s) made

Date pupil record transferred