Name / Click here to enter text. / DOB / Click here to enter a date. /
School / Click here to enter text. / Year Group / Choose an item. /
Date of PEP meeting / Click here to enter a date. /
SECTION A – Documents to bring to the meeting
Previous PEP form / IEP/PSP where appropriate
Exclusion information / Attainment data
SECTION B – Meeting preparation
Section / To be completed by / Before the meeting / At the meeting
1 / People / School / √
2 / Young person’s voice / School / √
3 / School contribution / School / √
4 / PEP Review and Action Plan / School / √
5 / Essential information / Social Worker / √
SECTION 1 – People at this meeting
Who? / Name / Address / Phone number
& e-mail
Carer/s the young person lives with / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Parent/s / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Designated teacher / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Class teacher / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Social Worker / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Independent Reviewing Officer / Click here to enter text. / Civic Centre
Southampton
SO14 7LY / Click here to enter text. /
SCC Virtual School / Click here to enter text. / Civic Centre
Southampton
SO14 7LY / Click here to enter text. /
Named Nurse / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Other / Click here to enter text. / Click here to enter text. / Click here to enter text. /
SECTION2 – The Young Person’s Voice (to be completed prior to the meeting)
What’s going well at school:
Click here to enter text. / What’s not going well at school:
Click here to enter text.
I’m doing well at:
Click here to enter text. / I need more help with:
Click here to enter text.
Out of school, I like doing: Click here to enter text.
and I go to: Click here to enter text.
When I leave school, I’d like to be: Click here to enter text.
To do that, I need to: Click here to enter text.
Is there anything stopping me doing even better at school? / Yes ☐ / No ☐
If yes, what is it and what can be done about it?
Click here to enter text.
Bullying can be a problem for young people.
Have I been bullied?
If yes, what did I, or an adult, do about it?
Click here to enter text.
Has the bullying stopped? / Yes ☐ / No ☐
I find it easy to attend school every day
If not, why not? Click here to enter text.
What have I achieved and how has it been celebrated (e.g. house points, certificates)
Click here to enter text.
SECTION3 – School Contribution – Achievement & Attainment
Please fill in the KS3 table below for a KS3 pupil or the KS4 tables for a KS4 pupil.
Please also provide a print out of all available SIMS/other assessment data.
KEY STAGE 2 PRIOR ATTAINMENT – PRE 2016
Reading (NC sub level required) / Click here to enter text.
Writing (NC whole level required) / Click here to enter text.
Maths (NC sub level required) / Click here to enter text.
KEY STAGE 2 PRIOR ATTAINMENT – POST 2016
Reading (scaled score or N,B or A required) / Click here to enter text.
Writing (Teacher Assessment) / Choose an item.
Maths (scaled score or N,B or A required) / Click here to enter text.
KEY STAGE 3 / Currently working at / End of year target / On track to meet end of year target / Comment
English / Choose an item. / Choose an item. / Yes ☐ No ☐ / Click here to enter text.
Maths / Choose an item. / Choose an item. / Yes ☐ No ☐ / Click here to enter text.
If the pupil did not achieve the expected standard or above at the end of KS2/KS3 how is this being addresed and how is additional funding being used to bring the pupil to this level or above?
KEY STAGE 4 / Currently working at / End of KS4 target / On track to meet end of year target / Comment
English / Choose an item. / Choose an item. / Choose an item. / Click here to enter text.
Maths / Choose an item. / Choose an item. / Choose an item. / Click here to enter text.
KEY STAGE 4 OTHER SUBJECTS
(Please list all subjects being studied) / Currently working at / End of KS4 target / On track to meet end of key stage target?
Bucket / Subject / 9 – 1
A* - G / 9 – 1
A* - G
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Choose an item. / Click here to enter text. / Choose an item. / Choose an item. / Yes ☐ No ☐
Detailed information:
Is this pupil on track to achieve a positive Progress 8 score?
Click here to enter text.
Other assessment information e.g. CATs, reading age, standardised scores
Date / Assessment type / Outcome
Click here to enter a date. / Click here to enter text. / Click here to enter text. / Click here to enter text.
Click here to enter a date. / Click here to enter text. / Click here to enter text. / Click here to enter text.
Click here to enter a date. / Click here to enter text. / Click here to enter text. / Click here to enter text.
English / Click here to enter text.
Maths / Click here to enter text.
Other / Click here to enter text.
Attendance
Sessions absent since start of academic year / Total absence / Unauthorised absence
No. of
Sessions / % / No. of
Sessions / %
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Is pupil at risk of being persistently absent (10%) / Yes ☐ No ☐
Number of sessions lost through fixed term exclusion since last PEP / Click here to enter text.
Is there a Pastoral Support Plan in place? / Yes ☐ / No ☐
Attendance – contextual information
Click here to enter text.
Special educational needs and disabilities
Please only complete if applicable
If the young person has anything in the list below, please check the box and make sure a copy is with this plan (including a provision map if applicable):
School support ☐ / Pastoral Support Plan ☐
Individual Education Plan ☐ / SEN statement/EHCP ☐
If an EHCP has been requested, to which authority? Click here to enter text.
SECTION 4: PEP Review & Action Plan
Pupil Premium - Review of previous spend since last PEP
Area of curriculum identified for support / Agreed intervention / Cost / Impact of intervention
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Total £ / Click here to enter text. /
Forecast of spend before next PEP
Area of curriculum identified for support / Agreed intervention / Cost / Impact of intervention
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Total £ / Click here to enter text. /
Please translate your forecast of spend into a SMART Action Plan below.
Action Plan
Action to be taken / Lead Person / By when? / Impact / Completed?
Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Yes ☐
No ☐
Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Yes ☐
No ☐
Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Yes ☐
No ☐
Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Yes ☐
No ☐
Click here to enter text. / Click here to enter text. / Click here to enter a date. / Click here to enter text. / Yes ☐
No ☐
SECTION 5 – PEP Essential Information Record (Social Worker responsibility)
Date of next
PEP meeting / Click here to enter a date. / Venue / Click here to enter text. / Meeting time / Click here to enter text.
Date of next LAC Review Meeting / Click here to enter a date.
Date of next LAC medical / Click here to enter a date.
School history (to be completed before the meeting)
Name & address of school / Date started / Date left / Reason for leaving / Attendance % / No. of FTEs
Click here to enter text. / Click here to enter a date. / Click here to enter a date. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter a date. / Click here to enter a date. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter a date. / Click here to enter a date. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter a date. / Click here to enter a date. / Choose an item. / Click here to enter text. / Click here to enter text. /
Click here to enter text. / Click here to enter a date. / Click here to enter a date. / Choose an item. / Click here to enter text. / Click here to enter text. /
Exclusions record at current school
Fixed Term / Internal / Permanent
Total no. of exclusions / Total number of days / Click here to enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text.
Important information
Care status
(tickone option) / Full Care Order Yes ☐ / Section 20 Yes ☐
Interim Care Order Yes ☐ / Placement Order Yes ☐
Click here to enter text. should be the first point of contact in an emergency situation.
Click here to enter text.will be responsible for health issues (vaccination/permission/medical emergencies)
Please specify any information that should be kept confidential:
Click here to enter text.
Please specify who is not allowed to contact the young person?
Click here to enter text.
Click here to enter text.is allowed to collect the young person from school.
Please specify ethnic background and any special needs:
Click here to enter text.
Click here to enter text.will sign to say if the young person can be photographed and go on school trips
The young person will ordinarily travel to school byClick here to enter text.
Click here to enter text.should be the recipient of school reports.
Click here to enter text.will attend parents’ evenings.
  • If you are a Southamptonschool, a copy of this completed PEP should be sent, via Anycomms, to “Virtual School”
  • If you are nota Southampton school, a copy of this completed PEP should be sent directly to:

Updated 06.10.16 1