89 questions
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Back Preview Get SCROLL to use this templateName | Text of question | Type of answer | Further notes | Data source | Mandatory? |
---|---|---|---|---|---|
pupil_forename | Forename | Text (single-line) | CBDS | Yes | |
pupil_middle_name | Middle name(s) | Text (single-line) | Optional | CBDS | |
pupil_pref_name | Preferred Name | Text (single-line) | Optional | CBDS | |
pupil_surname | Surname(s) | Text (single-line) | As stated on Birth Certificate. | CBDS | Yes |
pupil_dob | Date of Birth (dd/mm/yyyy) | Date | CBDS | Yes | |
pupil_gender | Is the child a ...? | List of choices | CBDS | Yes | |
pupil_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
pupil_line2_address | Name of city or town | Text (single-line) | Optional | CBDS | Yes |
pupil_postcode | Postcode | Text (single-line) | Yes | ||
pupil_home_tel | Home telephone number | Text (single-line) | Yes | ||
pupil_residence | Local Authority of the child's residence | List of choices | Local Authority to which Council Tax is paid. | CBDS | Yes |
pupil_lives_with | Who does the child live with at this address? | List of choices | Please select all that apply. You will be asked about any other addresses later in this form. | CBDS | Yes |
pupil_country_of_birth | Please select the child's country of birth from the list below. | List of choices | CBDS | Yes | |
pupil_nationality | Please select the child's nationality from the list below. | List of choices | If the child holds multiple nationalities, including British, please select British (United Kingdom) from this list. | CBDS | Yes |
pupil_arrival_in_uk | Please enter the date the child arrived in the UK. (dd/mm/yyyy) | Date | CBDS | Yes | |
pupil_asylum | Is the child an asylum seeker? | List of choices | CBDS | Yes | |
pupil_refugee | Is the child a refugee? | List of choices | CBDS | Yes | |
pupil_nhs_number | Child's NHS number | Text (single-line) | Found on the child's medical card or obtained from your doctor. | Yes | |
pupil_medical_condition | Does the child suffer from ANY medical condition, or take medication for any problem? | List of choices | If you tick any of the following, a letter from your GP or hospital consultant will be required to keep on the child's file.@|Select all that apply | Yes | |
pupil_meds | Does your child carry any of the following? | List of choices | Select all that apply | Yes | |
pupil_diet_needs | Does the child have any special dietary needs? | List of choices | Yes | ||
pupil_medical_support | Does the child receive any paramedical support? | List of choices | These are services which supplement and support medical work but do not require a fully qualified doctor. | CBDS | Yes |
doctor_practice_name | Name of the medical practice where the child is registered. | Text (single-line) | Yes | ||
doctor_name | Doctor's name | Text (single-line) | Yes | ||
doctor_practice_line1_address | Building name/number and street | Text (single-line) | Yes | ||
doctor_practice_line2_address | Name of town or city | Text (single-line) | |||
doctor_practice_postcode | Postcode | Text (single-line) | Yes | ||
doctor_practice_tel_number | Telephone number | Text (single-line) | Yes | ||
emergency_consent | Emergency consent | List of choices | Do you give consent for the school to act on your behalf in case of an accident or emergency? | Yes | |
pupil_first_language | Child's first language | List of choices | A language that a child is exposed to during early development and continues to be exposed to in the home or in the community.@|@|Note: A child exposed to more than one language (including English) during early development, is deemed to have a first language other than English, irrespective of their proficiency in English. | CBDS | Yes |
pupil_other_language1 | Other language that the child is exposed to at home from the list below. | List of choices | CBDS | Yes | |
pupil_other_language2 | If applicable, please select another language that the child is exposed to at home from the list below. | List of choices | CBDS | ||
pupil_other_language3 | If applicable, please select another language that the child is exposed to at home from the list below. | List of choices | CBDS | ||
pupil_in_care | Is the child, or has the child previously been, subject to a Local Authority Care Order? | List of choices | ie a looked after child | Yes | |
pupil_in_care_local_authority | Please provide the name of the Local Authority | List of choices | CBDS | Yes | |
pupil_in_care_social_worker | Social worker’s name and surname | Text (single-line) | Yes | ||
pupil_in_care_local_authority_date | Start date (dd/mm/yyyy) | Date | CBDS | Yes | |
pupil_sen_statement | Does the child have a Statement of Special Educational Needs? | List of choices | CBDS | Yes | |
pupil_sen_school | Please specify school named in the Statement | Text (single-line) | Yes | ||
pupil_sen_local_authority | Name of the Local Authority | List of choices | Yes | ||
pupil_sen_officer | Case Officer’s Name | Text (single-line) | Yes | ||
pupil_free_school_transport | Does the Local Authority provide free school transport? | List of choices | CBDS | Yes | |
pupil_free_school_meals | Is the child eligible for free schools meals? | List of choices | CBDS | Yes | |
pupil_religion | Religion of the child. | List of choices | Yes | ||
pupil_ethnicity | Please study the list below and tick one box to indicate the ethnic background of the child. | List of choices | Any information you provide will be used solely to compile statistics on the school careers and experiences of pupils from different ethnic backgrounds, to help ensure that all pupils have the opportunity to fulfil their potential. These statistics will not allow individual pupils to be identified. From time to time the information will be passed on to the Local Education Authority and the Department for Education (DfE) to contribute to local and national statistics. The information will also be passed on to future schools, to save it having to be asked for it again. | CBDS | Yes |
adult1_parentalresp | Does this person have parental responsibility? | List of choices | CBDS | Yes | |
adult1_relationship | Relationship to pupil | List of choices | CBDS | Yes | |
adult1_title | Title | List of choices | CBDS | Yes | |
adult1_forename | Forename | Text (single-line) | CBDS | Yes | |
adult1_surname | Surname | Text (single-line) | CBDS | Yes | |
adult1_mobile_number | Mobile number | Text (single-line) | Yes | ||
adult1_email | Text (single-line) | Yes | |||
adult1_same_address_as_pupil | Is home address the same as the child's home address? | List of choices | CBDS | Yes | |
adult1_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
adult1_line2_address | Name of town or city | Text (single-line) | Optional | CBDS | Yes |
adult1_postcode | Postcode | Text (single-line) | Yes | ||
adult1_home_tel | Home telephone number | Text (single-line) | Yes | ||
adult1_employment | Is this contact in employment? | List of choices | Yes | ||
adult2 | Is there a second adult? | List of choices | Yes | ||
adult2_parentalresp | Does this person have parental responsibility? | List of choices | CBDS | Yes | |
adult2_relationship | Relationship to pupil | List of choices | CBDS | Yes | |
adult2_title | Title | List of choices | CBDS | Yes | |
adult2_forename | Forename | Text (single-line) | CBDS | Yes | |
adult2_surname | Surname | Text (single-line) | CBDS | Yes | |
adult2_same_address_as_pupil | Is home address the same as the child's home address? | List of choices | CBDS | Yes | |
adult2_mobile_number | Mobile number | Text (single-line) | Yes | ||
adult2_email | Text (single-line) | Yes | |||
adult2_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
adult2_line2_address | Name of town or city | Text (single-line) | Optional | CBDS | Yes |
adult2_postcode | Postcode | Text (single-line) | Yes | ||
adult2_home_tel | Home telephone number | Text (single-line) | Yes | ||
adult2_employment | Is this contact in employment? | List of choices | Yes | ||
adult3 | Is there a third adult we need to know about? | List of choices | Yes | ||
adult3_parentalresp | Does this person have parental responsibility? | List of choices | CBDS | Yes | |
adult3_relationship | Relationship to pupil | List of choices | CBDS | Yes | |
adult3_title | Title | List of choices | CBDS | Yes | |
adult3_forename | Forename | Text (single-line) | CBDS | Yes | |
adult3_surname | Surname | Text (single-line) | CBDS | Yes | |
adult3_same_address_as_pupil | Is home address the same as the child's home address? | List of choices | CBDS | Yes | |
adult3_mobile_number | Mobile number | Text (single-line) | Yes | ||
adult3_email | Text (single-line) | Yes | |||
adult3_line1_address | House number/name and street | Text (single-line) | CBDS | Yes | |
adult3_line2_address | Name of town or city | Text (single-line) | Optional | CBDS | Yes |
adult3_postcode | Postcode | Text (single-line) | Yes | ||
adult3_home_tel | Home telephone number | Text (single-line) | Yes | ||
adult3_employment | Is this contact in employment? | List of choices | Yes | ||
declaration_adult1 | I confirm by ticking the box below that all the information given in this form is true to the best of my knowledge. | List of choices | Yes | ||
declaration_adult2 | I confirm by ticking the box below that all the information given in this form is true to the best of my knowledge. | List of choices | Yes | ||
declaration_adult3 | I confirm by ticking the box below that all the information given in this form is true to the best of my knowledge. | List of choices | Yes |