North West Schools
Managed Move agreement form
Young person & school details
Home School:
SLT Signature:
Home school:
Host School:
Student’s Name:
Date of Birth:
Head of Year:
Year Group:
Free School Meals?:
Yes / No
CLA?:
SEN Stage:
Attendance:
Have all the necessary checks been made to ensure that a managed
transfer is appropriate for this student?
Have the AIP been informed?
Yes / No
Yes/No
Student’s
Address:
Parent/Carer
Contact Details (1):
Parent/Carer
Contact Details (2):
We agree to a transfer to another school for a trial period.
Student &
Parental Consent:
Signed by Student:
Signed by Parent/Carer:
Reasons for proposing a managed transfer:
School Based Support Strategies:
External
Provision &
Support:
Supporting
Agencies:
Contact
Details:
Academic Information:
If possible please provide a copy of last school
report.
Option choices:
(Y9, Y10 & Y11 only)
Student Targets:
Target 1:
Target 2:
Target 3:
Notes /
Comments /
Actions:
I understand what a ‘managed move/transfer’ is and have had this explained to me. I understand my role in
ensuring that this managed move is successful and agree that should the ‘managed move’ fail the move will be
withdrawn and a return to the home school will be made.
Signed by Student:
Signed by Parent/Carer:
Signed by Proposed (Host)
School:
Role:
Date:
Start Date at Host School:
Review Date:
(1)
(2)
Proposed on roll date: