Term-Time Holiday: Penalty Notices

This referral form should only be used by schools requesting consideration of a Penalty Notice for unauthorised leave of absence taken during term time.

Before submitting a request, please ensure you have read and understood the Penalty Notice Code of Conduct (August 2024) and have gathered all required evidence and supporting documentation.

Please read all sections carefully before completing and uploading information through this form.

If you would like an overview of how the process works, please visit: here.

Important

This form is only for requests relating to unauthorised term time holiday absence.

If you are seeking legal intervention for irregular school attendance, persistent absence or other attendance concerns, please follow the guidance and referral process outlined here:

Penalty Notices: Guidance for Schools

Using the correct referral route helps ensure requests are considered promptly and that schools provide the appropriate evidence for the type of intervention being requested.

Penalty Notice referral form: Term Time Holiday

Use this form to refer cases where a pupil has taken unauthorised leave of absence during term time and the absence may meet the criteria for a Penalty Notice. Schools should ensure attendance registers have been completed accurately and all required supporting information is provided before submitting a referral. The Attendance Support Team will review the information submitted and determine whether the case meets the threshold for Penalty Notice consideration in line with current attendance regulations and local authority guidance.

School Details

Name of Referrer(Required)

Job title of Referrer(Required)

School Name(Required)

Email Address(Required)

Please read the following statement(Required)

I agree to support the full Fixed Penalty Notice process, including providing witness statements and headteachers certificates (S566s) when asked for cases proceeding to prosecution. The Headteacher agrees that where a referral is completed by a member of staff other than the Headteacher this will still be the case. I can confirm that our school attendance policy clearly lays out the expectations for pupil attendance and what regular attendance means. Please ensure all requests for fixed penalty notices are submitted to the Local Authority Attendance Team within 15 school days of absence meeting the criteria

I confirm

Pupil Details

UPN(Required)

Please input the unique pupil number

Name(Required)

First Last

Year Group(Required)

Please note for Reception children statutory school age starts the term after the child turns 5. Please note for year 11 pupils, we will not be accepting any new referrals past the end of the Spring Term.

Date of birth(Required)

Child's Current Attendance %(Required)

Please enter a number from 0 to 100.

Which of the following apply?(Required)

Looked after child

Child Protection Plan

Child in Need

SEN

EHCP

None of the above

Address (including postcode)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Full name of main parent (or carer)(Required)

Title First Last

Full name of other parent (or carer)

Title First Last

If parents do not live in the same property please provide other address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

National Framework escalation process

According to your records, what level of the PN National framework is this referral regarding?(Required)

According to your records, has the child been issued a previous penalty notice under the PN National Framework (since August 2024)?

1st offence

2nd offence

3rd offence

I don’t know

Has the pupil been registered at your school for the past three academic years?(Required)

This is so we can determine if a check needs to be made with another borough about their standing within the national framework.

Yes

Please provide any previous school name and borough/local authority.(Required)

If the child has come from another borough or school in the previous 3 years, please state which so we can make the appropriate checks

Unauthorised leave in term time

This should be within 10 weeks to the date of referral unless before summer holidays. Please note we will not process a referral if the student is still away, you will need to refer once the pupil has returned to school.

Would you like this referral to be considered for a warning letter?(Required)

If you have agreed or prefer a warning letter to be sent in this instance please select ‘yes’ below.

Yes

Absence start date(Required)

Date the pupil returned(Required)

Please note we will not process a referral if the student is still away, you will need to refer once the pupil has returned to school – this can be after their first present mark.

Number of unauthorised sessions(Required)

There are 2 sessions a day – morning and afternoon