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 the Local Authority informed. Please email completed forms to SEND0-25businesssupport@solihull.gov.uk. 

Signed	Name	Relationship to pupil