School/Setting : 	
Pupil name:		Year Group:		
UPN:		DOB:		
SEN Status:		LAC Status:		

Has there been a team around the child meeting?            YES /NO   Date: 	
Team Around the Child Meeting Attendance Details	
Name	Relationship to the pupil	Organisation/Family	

			

			

REASON FOR REDUCED TIMETABLE	
Re-integration after fixed term exclusion		To help a pupil manage school based anxiety		
Reintegration after prolonged absence		As part of a medical plan
		
Reintegration after period of school refusal		Other		

BRIEF DETAILS REGARDING WHY THIS PUPIL REQUIRES A REDUCED TIMETABLE

	

NAMED PERSON RESPONSIBLE FOR THE PLAN IN SCHOOL	
Name:		
Position:		

REVIEW DATE	
Start date of reduced timetable:		
Review date of reduced timetable:		

FURTHER SUPPORT AND INTERVENTION
	DETAILS	
Are there any safe guarding concerns?
		
Has Specialist Teacher support been requested?		
Is a medical plan attached?
		
Is alternative provision to be considered?
		
Is a reintegration plan attached setting out objectives/success criteria and support required		

Other Agencies involved: (Eg. Engage, Solar, SISS, SENDIAS, YOS)	Key Worker- Name	

		
		
To be agreed by parent/carer, Head Teacher and approved by the Local Authority
Signed 	Name 	Relationship to pupil