Example of Notice of Application for Independent Review following a Child's Permanent Exclusion from School

This is an example of the Notice of Application for Independent Review Against Permanent Exclusion form for your reference purposes. The form to be filled in will be sent in the post by the Local Education Authority.

Education Act 2002

Notice of application for Independent Review

Please read the accompanying Notes for Guidance before completing.

Please complete in block letters and black ink.

1. Full Name of Parent or Guardian

2. Home address

Mobile/ Daytime Telephone Number

Email address

3. Full Name of Excluded Pupil

Date of Birth

4. School which Pupil has been excluded from

5. Do you wish to attend the hearing? YES/NO

6. Do you wish to request the appointment of a Special educational needs (SEN) expert at the hearing? YES/NO

7 If the school your child has been excluded from is an academy do you want to request a representative of the Local Authority attend the hearing? YES/NO

8. If you have a disability and need assistance, please give details below:

9. If you need an interpreter or signer, please give details below, including language:

10. Do you wish to be represented at the hearing? YES/NO

11. If you wish to be represented, please give the following details:

Name of your representative

Occupation of representative

Address of representative

Telephone Number

12. Please state if you will be legally represented and, if so, provide details:

13. If you wish to bring a witness or witnesses to the hearing please give the following details:




(Attach a separate sheet if necessary)

14. If you wish to bring a witness or witnesses to the hearing please give your reasons:

15. Please state briefly the nature of the evidence your witness or witnesses will provide:

16. Is your child on School Action or School Action Plus or does he/she have a statement of special education needs? YES/NO

If yes, please give details.

17. Is your child undergoing any statutory assessment process? YES/NO

If yes, please give details.

18. Do you believe your child has any special educational needs? YES/NO

If yes, please give details.

19. Reasons for applying for an independent review. You must put your reasons - (attach extra sheets if necessary)

20. Do you feel your child has been discriminated against for any reason? YES/NO

If yes, please give details (attach extra sheets if necessary)

21. Any other information you consider relevant to the Review.

Please attach any supporting evidence to this form.

Surrey County Council (the 'Council') respects your privacy rights and is committed to ensuring that it protects your details, the information about your dealings with the Council and other information available to the Council ('your information'). In accordance with the Data Protection Act 1998, the Council will use your information, for the purpose of processing your school admission appeal(s), to (a) deal with your requests and administer its departmental functions, (b) meet it's statutory obligations, and (c) prevent and detect fraud. The Council may share your information (but only the minimum amount of information necessary to do the above and only where it is lawful to do so) within the Council (including other admission authorities, central government departments, law enforcement agencies, statutory and judicial bodies and independent appeal panels). The Council may also use and disclose information that does not identify individuals for research and strategic development purposes. The School Appeals Service and Local Authority reserve the right to verify the information contained in this form.

Declaration and Signature of Parent/Carer

I wish to exercise my right to request an independent review. I certify that I am the person with parental responsibility for the child named in section 3 and the information given is true to the best of my knowledge and belief. I understand that if I do not attend the hearing and I do not send a representative my review will be heard in my absence using the information I have supplied on this form along with any other information I have sent to the School Appeals Service before my hearing date. I understand that any false or deliberately misleading information given on this form and/or supporting information may render this appeal invalid and/or lead to further appropriate action being taken. I have read and understood the accompanying Guidance Notes. I understand that any evidence submitted after the stated deadline may not be considered at my appeal hearing.



This form must be received by The School Appeals Service, 1st Floor, Dakota, De Havilland Drive, Weybridge, KT13 0YP within 15 school days of the date of Notice from the Governing Board of its decision that your child should not be reinstated at the school.

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