P1
P2
P3
P4
P5
P6
P7
S1
S2
S3
S4
S5
S6
Full name:
Gender: male
For office use only
Input by
Date Ref
Placing Request Application Form
Please return to: North Ayrshire Council, Education Service, Communities Directorate,
Cunninghame House, Irvine KA12 8EE or educationresources@north-ayrshire.gov.uk
1 Your child’s details
female
Date of birth:
dd/mm/yy
2 Your details
Mr Mrs
Ms
Miss
Title:
Full name:
Address
Postcode
Work phone:
Home phone:
Mobile:
Email:
If you would like to discuss your application by telephone, please complete the security
question answer below.
What was the name of your first primary school?
Security Question:
Answer:
3 School details
I would like my child to go to (specify school):
The catchment school for my area is:
(If P1 application school my child is
registered to attend)
My child currently goes to (name of school/nursery):
My child should go into (please tick one box):
Stage in primary
Stage in secondary
Your child has older brothers or sisters continuing their attendance at the school.
Please give details below.
Name of brother(s) or
sister(s)
:
Stage(s)
:
4 Priorities
We grant placing requests on the basis of the priorities set out
below. Please tick one box below that applies to your situation.
1
2
Medical reasons. Please list medical reasons below. Please note that these
should be supported by the family doctor who is of the view that the child or
young person could only be educated with difficulty in another school.
Data Protection
Further information on how the Council handles your personal information can be found on:
https://www.north-ayrshire.gov.uk/privacy-policy.aspx
If your child currently attends a school or nursery outside the North Ayrshire Council area, we would
also seek access to the education records for your child from that education authority. By signing
the declaration below, you consent to North Ayrshire Council's Education Service receiving a copy
and access to your child’s current educational record held by that education authority.
If you require further information on how the Council will process your application, information
on schools or help with completion of this application form, please contact:
01294 310000.
Please add any other relevant information here:
We need your details for the purposes of dealing with your application for a placing request and they
will be used for the purposes of the Council's public functions. The Council may check your details
with other information held and may share these with other council services and other local authorities
to check the accuracy of the information and to prevent or detect fraud or crime or to protect public
funds.
Declaration
1 Please tick appropriate box:
I agree that if this placing request is granted,
it will apply at the start of the next session (August 20

).
Having considered the educational advice I have received about transferring my
child during a session, I want you to consider this placing request now.
2 Does your child have additional support needs?
Yes (Please provide details)
Does your child have a co-ordinated support plan?
My child has a co-ordinated support plan, or a co-ordinated support plan is being
prepared or considered in respect of my child, in terms of the Education
(Additional Support for Learning) (Scotland) Act 2004.
My child does not have a co-ordinated support plan and no co-ordinated support plan
is being prepared or considered in respect of my child, in terms of the Education
(Additional Support for Learning) (Scotland) Act 2004.
3
4
I have read and understood the statement on transport.
I have read and understood the statement above on Data Protection and give
consent for the information detailed to be accessed and shared where
necessary.
Your signature:
Date:
No
North Ayrshire Council provides free transport for all primary pupils who live more than two miles from
their catchment primary school, and three miles from their delineated secondary school, by the shortest
safest walking route. Arrangements for free school transport may be made for children with additional
support needs.
Education and Youth Employment do not provide transport for those pupils in receipt of a
placing request other than in exceptional circumstances.
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