Referral to Children Missing Education (CME) Officer (form 50)

This form is to be completed to refer a child to the Children Missing from Education Officer for Derby City. The appropriate checks will be carried out and the result of the investigation will be fed back to you. Please be aware that once a school application is in place the case to the CME Officer will be closed. Similarly if this child is not at the address provided Derby City will not take case responsibility and will be passed back to you accordingly. This is in line with CME Guidelines 2016

Please also be aware that this does not replace safeguarding procedures. Should you have concerns about a child and require a safe and well check then please contact the First Contact Team on 01332 641172 and also the police on 101.

We will treat all information provided in confidence and in accordance with our privacy notice.

The fields marked with an asterisk (*) are required fields. All the information you enter will be submitted securely.

* Your name

* Your email address

* Confirm Your email address

Email addresses do not match.

* Referring Local Authority

* Name of professional

* Contact number

* Are there immediate concerns?

No

Yes

* If you think the young person may be at risk please consider a safe and well check with the police and ask them to file a missing person’s report. Please tick if you have already done this

The police have been contacted

Missing Child’s Personal Details:

* Name

* Gender

Please select Male Female Other

* Date of birth

* Ethnicity

Please select White British White Irish Other White background Dual Heritage - White and Black Caribbean Dual Heritage - White and Black African Dual Heritage -White and Asian Dual Heritage - Other Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or AsianBritish - Other Black or Black British - Caribbean Black or Black British - African Black or Black British - Other Chinese Other

* Other ethnicity

UPN

* Parent/carer name(s)

* Telephone number

* Last known school

* Are they still on roll?

No

Yes

* Date removed from roll

* Last known address

* New address

* How have you been made aware of this new address

* How have they informed you

Letter

Phone call

Email

Text message

Verbally in school

* Does the child have a disability?

No

Yes

* Details of disability

* SEN status

No

Yes

* SEN status details

* Early intervention

Please select Current Historical None

* Early intervention details

* CP status

Please select Current Historical None

* CP details

* Is the child in care?

No

Yes

* LA with LAC responsibility

Contact details including emergency contacts:

1st contact name

1st contact relationship

1st contact phone number

2nd contact name

2nd contact relationship

2nd contact phone number

3rd contact name

3rd contact relationship

3rd contact phone number

4th contact name

4th contact relationship

4th contact phone number

Siblings of child - where applicable

1st sibling name

1st sibling date of birth

1st sibling school

Date information shared with 1st sibling's school

2nd sibling name

2nd sibling date of birth

2nd sibling school

Date information shared with 2nd sibling's school

3rd sibling name

3rd sibling date of birth

3rd sibling school

Date information shared with 3rd sibling's school