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["REFERRAL FORM FOR EDUCATION PANEL"]
["Please answer as fully as possible "]
[]
["Reference","Number","Childs First Name","Childs Surname","DOB","Age","Year  Group","Gender","Ethnicity"]
[]
["Address ",null,"District","Postcode","Current / Last school attended "]
[]
["PLEASE DETAIL"]
[" Managed Move School tried",null,"Alternative Provision arranged ",null,null,null," Home tutoring offered  "]
[]
["Please briefly detail what type of curriculum / timetable is being offered, and what hours of provision are being offered per week? "]
[]
["What is the current level of engagement with this offer (include current attendance percentage and attach printout from provider/school if available)?"]
[]
["Agency / Service involvement ",null,null,"Status of Young Person",null,"Which school is responsible for the child?"]
[]
["Does the YP have an Education Health Care Plan or has a request for an EHCP been made/ tried previously? ",null,null,"If they have an EHCP when was the last annual review undertaken?"]
[]
["Case manager",null,null,"Presenting Manager at Panel"]
[]
["What is the Barrier to successful engagement / Issue that needs resolving"]
[]
["What has previously been tried?"]
[]
["Any Risk issues that needs to be considered?"]
[]
["Is there a proposal  / solution identified? Has this been rejected and if so what were the reasons why?   "]
[]
["Is there any timescale by which this solution needs to be implemented?"]
[]
["If no solution identified please specify their Interests / Educational levels / Favourite subjects / Career aspirations to enable the Panel to explore potential solutions  "]

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[]
[]
[]
[null,null,null,"Status of Young Person"]
[null,null,null,"*PLEASE SELECT*"]
[null,null,null,"CIC"]
[null,null,null,"CIN"]
[null,null,null,"CP"]
[null,null,null,"MST"]
[null,null,null,"TF"]
[null,null,null,"YOT"]
[null,null,null,"Other  - type in  blank cell"]
[]
[]
[null,null,null,"Agency / Service involvement (drop down- Elective Home Education Team, SENAR, Fair Access Team, Admissions, Sharing Network Panel, Exclusions team, COBs schools"]
[null,null,null,"*PLEASE SELECT*"]
[null,null,null,"Admissions & Appeal Team"]
[null,null,null,"COBs schools"]
[null,null,null,"Elective Home Education Team"]
[null,null,null,"Exclusions team"]
[null,null,null,"Fair Access Team"]
[null,null,null,"SENAR"]
[null,null,null,"Sharing Network Panel"]
[null,null,null,"Other  - Select blank cell"]
[]
[null,null,null,"Reference Number"]
[null,null,null,"*PLEASE SELECT*"]
[null,null,null,"Carefirst"]
[null,null,null,"Care Director"]
[null,null,null,"Impulse"]
[null,null,null,"Other  - type in  blank cell"]
[]
[null,null,null,"Ethnicity"]
[null,null,null,"*PLEASE SELECT *"]
[null,null,null,"Any Other Asian Backgound"]
[null,null,null,"Any Other Mixed Background"]
[null,null,null,"Any Other White Background"]
[null,null,null,"Bangladeshi"]
[null,null,null,"Black African"]
[null,null,null,"Black Carribean"]
[null,null,null,"Black Other"]
[null,null,null,"Chinese"]
[null,null,null,"Gypsy/Roma"]
[null,null,null,"Indian"]
[null,null,null,"Information not yet Obtained"]
[null,null,null,"Mediterranean"]
[null,null,null,"Other Ethnic Group"]
[null,null,null,"Pakistani"]
[null,null,null,"Refused"]
[null,null,null,"Romanian"]
[null,null,null,"Traveller of Irish Heritage"]
[null,null,null,"Vietnamese"]
[null,null,null,"White - European"]
[null,null,null,"White - Irish"]
[null,null,null,"White - UK heritage"]
[null,null,null,"White and Asian"]
[null,null,null,"White and Black African"]
[null,null,null,"White and Black Caribbean"]
[null,null,null,"Other  - type in  blank cell"]