PN referral form
Name and Designation of Referrer | |
School |
Child's full name | |
Child's date of birth | |
Address | |
Full name of Mother (or Carer) | |
Full name of Father (or Carer) | |
Parent(s) phone number |
Period of absence for which penalty notice is requested | From | To |
Checklist of information for referral to ACE for consideration of the issuing of a penalty notice | Tick |
Referral meets the threshold for consideration for issuing of a Penalty Notice in terms of Penalty Notice Code of Conduct? (Section 3) | |
Attendance printout for previous and current years attached | |
Referral for Penalty Notice is in relation to a persistent absence rate of below 85% unauthorised absence over a six week period | |
Parent/carer has taken child out of school for leave in term time without the permission of school staff | |
School considered history of previous leave taken in term-time and previous attendance rate | |
Evidence of action undertaken by school staff to resolve the attendance issues to be attached - including copies of any communication to and from parents, original application for exceptional leave from parent/carers where applicable, letters/documents from parents, attendance contracts, etc | |
Evidence attached of consultation with other professionals involved should be attached | |
Attendance details of siblings - where appropriate | |
Please provide summary of action school took before and after pupil returned to school (eg: phone conversation or meeting with family):
| |
Please provide summary of parent/guardian response:
|
ACE will respond to requests within 10 school days of receiving the request for consideration of a penalty notice.
- download the Penalty Notice Referral Form [PDF] (file size 118Kb)
- download the Penalty Notice Referral Form Word version (file size 187Kb)