Term-Time Holiday and Penalty Notice Referrals

This form should be used by schools requesting consideration of a Penalty Notice for:

Unauthorised leave of absence taken during term time (term-time holiday cases); and
Cases where a Penalty Notice has been agreed as the appropriate outcome following Legal Intervention Triage for irregular attendance or persistent lateness.

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. Where a referral follows Legal Intervention Triage, details of the triage discussion and agreed outcome must be included.

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 referrals where a Penalty Notice is being requested.

For cases of persistent absence or persistent lateness, schools must have consulted with their allocated Education Welfare Officer and followed the agreed attendance support and intervention processes before seeking a Penalty Notice outcome.

If you are seeking advice on attendance concerns, support with attendance intervention strategies, or consideration of legal action other than a Penalty Notice, please follow the guidance and referral processes 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 to support the type of intervention being requested. Submission of a referral does not guarantee that a Penalty Notice will be issued, as all requests are assessed against statutory guidance, local authority procedures and the available evidence.

Penalty Notice: Referral Form

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. This form should also be used where a Penalty Notice has been agreed as the appropriate outcome following a Legal Intervention Triage meeting for cases of non-attendance or persistent lateness.

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

Term-Time Holiday and Penalty Notice Referrals

Important

Penalty Notice: Referral Form

School Details

Pupil Details

National Framework escalation process

Unauthorised leave in term time

Legal Intervention Triage

Supporting evidence