Author: Ms A Darlison (Staff)

ATTEND Form for students
For the assessment of factors contributing to school non-attendance

Name:
Year/Form/Class:
Date:

My strengths
What are you good at? What do you enjoy?
When have you had good attendance at school?
What helps?
Who are your friends?
If you could name one adult you trust at school, who would it be?

What is stopping me from going to school? Circle or highlight.

Worry
I am worried about:
open spaces being bullied getting sick/germs/viruses
feeling trapped having a panic attack doing badly in lessons
crowds public transport socialising with other people
the school bus getting into trouble something else______________
I am so afraid of school that I:
sweat breath too fast cry have a racing heart
panic run away get angry find it hard to sleep on school nights
My health and wellbeing
I have:
migraine headaches IBS dyspraxia severe period pains
an eating disorder ADHD dyslexia hearing problems
sight problems (including CVI) OCD depression anxiety/panic attacks
speech and language difficulties autism seizures physical disability
another condition not list here_______________________________________________________
I feel like I am in the wrong gender body
Sensory overload
I find it hard to put up with:
the fabric of school uniform smells moving between lessons
being too close to other noise bright lighting
something else in the school environment_______________________________________________
Fitting in
I am being bullied I have a bad reputation at school
I recently lost a good friend I feel lonely and I don’t really have friends
I have recently fallen out with someone
I am having problems involving social media or cyberbullying
I feel I don’t fit in with others. Others don’t understand me
I feel I don’t fit in with others because I am a different religion or race
I feel I don’t fit in with others because I am gay/lesbian or have a different gender identity
School work and teachers
I find work too hard I find the work too easy
I am having trouble with a certain teacher I find school rules much too strict
I worry teachers with get angry or lose patience with me I don’t trust the teachers
I am worried about doing PE or getting changed for PE I am really worries about exams

Changes
I recently moved (circle or highlight):
schools from primary to secondary year group house
to the UK
English is not my first language and I am still learning it
Things at home
I am worried that my parent or carer is not well
My parent or carer worries a lot about me not being well
It is not always safe at home because of fighting and arguments, drinking or drugs
We have had a death in our family
We have had stressful things to cope with at home (e.g. house fire, burglary, parent/carer lost their job)
We have had a big change in our family (e.g. new baby, new parent, new step-sisters/brothers, parents separated)
I have to look after my parent, carer or brothers and sisters because sometimes I am the only one who can
We worry a lot about having enough money
There are lots of problems with where we live (e.g. damp, too crowded, we keep having to move, disagreements with neighbours or landlord)
My parent or carer finds it hard to get me to school in the mornings
I feel really worried about being away from my parent or carer—I worry about them the whole time we are apart
We don’t feel school is that important in our family—we think there are other ways of learning things
Do any of these other things stop me getting back to school?
I have access to comforts (e.g. computer, phone, play station or X-box, internet, TV, food, staying in bed or on the sofa, cigarettes, drugs)
I have a girlfriend/boyfriend off school
I have friends who are also off school
Other people in my family are at home during the day
I work and earn money while I am out of school
I get extra attention from, and time with, a parent or carer
I can completely control my environment at home (e.g. what I wear, who I see, when I go to bed or get up, what I eat, routines)
I am:
involved in gang activities
part of a radical religious or nationalist group
In a relationship with someone much older than me
I do a lot of online gaming and have friends through it
I am learning what I need to online or through a friend or family member
I feel that school is pointless or do not want to be part of ‘the system’

Things that make it harder to go back to school
I don’t know how to explain why I have been away to friends
I worry about facing my teachers
I worry that if I get into school, they won’t let me leave if I need to
I feel safe at home
I don’t think I can catch up with school work that I missed
No-one is really helping me
I go to bed too late or sleep badly and have trouble waking up early. I feel tired and sometimes catch up with sleep during the day
People disagree about how to help me
My parents and my teachers don’t get along

Is there anything else that stops you going to school ?
Of all the reasons circled or highlighted on this form, which are the most important?
What is good about school?
What do you hope to do when you leave school?