Seeking Change: Application for DBE Approval

When will the change come into force?*

DayMonthYear
Effective Date of Change
Purpose of Request*

Change of NameChange of Age RangePublished Admissions Number IncreasePublished Admissions Number DecreaseCollaborationFederationChange of Status (VC to VA)Multiple Site Authorisation

Change of Name
Proposed Name
Please ensure this is the full name of the school including any reference to VC, VA or nursery provision
Have you investigated any historical and/or cultural implications on the proposed name?

YesNo
Please provide information.
Please give details of the Governors' rationale for the change of name including information on any potential impact to the local community.
Has the school community been informed of the proposed change of name?

YesNo
Date of Governors' discussion on the proposed name.

DayMonthYear
Date
Minute extract of Governors' discussion on the proposed name.

Cancelof
Date of Governors' Resolution to the change of name.

DayMonthYear
Date
Governors' Resolution to the change of name.

Cancelof
Are the MAT aware of the change of name?

YesNoN/A
Date of MAT approval.

DayMonthYear
Date
Head's Signature

Clear
Chair of Governor's Signature

Clear
MAT Signature

Clear
Change of Name Application Date

DayMonthYear
Date

Change of Age Range
Change of Age Range

FromTo
Please give details of the Governors' rationale for the change of age range including information on any potential impact to the local community.
Date of Governors' discussion on the proposed change of age range.

DayMonthYear
Date
Minute extract of Governors' discussion on the proposed change of age range.

Cancelof
Date of Governors' Resolution to the change of age range.

DayMonthYear
Date
Governors' Resolution to the change of age range.

Cancelof
Are the MAT aware of the change of age range?

YesNoN/A
Evidence of MAT approval to change of age range.

Cancelof
Are the Local Authority aware of the change of age range?

YesNo
Evidence of LA discussions together with consent and demographic data in support of change of age range application.

Cancelof
Head's Signature

Clear
Chair of Governor's Signature

Clear
MAT Signature

Clear
Change of Age Application Date

DayMonthYear
Date

PAN Increase
Published Admissions Number Increase

FromTo
Please give details of the Governors' rationale for the PAN increase including information on any potential impact to the local community.
Minute extract of Governors' discussion on proposed PAN increase.

Cancelof
Date of Governors' Resolution to PAN increase.

DayMonthYear
Date
Governors' Resolution to PAN increase.

Cancelof
Are the MAT aware of the PAN increase?

YesNoN/A
Evidence of MAT approval to PAN increase.

Cancelof
Are the Local Authority aware of the PAN increase?

YesNo
Evidence of LA discussions together with consent and demographic data in support of PAN increase application.

Cancelof
Head's Signature

Clear
Chair of Governor's Signature

Clear
MAT Signature

Clear
PAN Increase Application Date

DayMonthYear
Date

PAN Decrease
Published Admissions Number Reduction

FromTo
Please give details of the Governors' rationale for the PAN reduction including information on any potential impact to the local community.
Minute extract of Governors' discussion on proposed PAN reduction.

Cancelof
Date of Governors' Resolution to PAN reduction.

DayMonthYear
Date
Governors' Resolution to PAN reduction.

Cancelof
Are the MAT aware of the PAN reduction?

YesNoN/A
Evidence of MAT approval to PAN reduction.

Cancelof
Are the Local Authority aware of the PAN reduction?

YesNo
Evidence of LA discussions together with consent and demographic data in support of PAN reduction application.

Cancelof
Head's Signature

Clear
Chair of Governor's Signature

Clear
MAT Signature

Clear
PAN Decrease Application Date

DayMonthYear
Date

Collaboration
Please give details of the school(s) you wish to collaborate with.
Please give details of the Governors' rationale for the collaboration including information on any potential impact to the local community.
Minute extract of Governors' discussion on proposed collaboration.

Cancelof
Date of Governors' Resolution to the collaboration.

DayMonthYear
Date
Governors' Resolution to collaborate.

Cancelof
Are the Local Authority aware of the collaboration?

YesNo
Evidence of LA discussions in support of the collaboration application.

Cancelof
Are the school community aware of the proposed collaboration?

YesNo
Head's Signature

Clear
Chair of Governor's Signature

Clear
Collaboration Application Date

DayMonthYear
Date

Federation
Please give details of the school(s) you wish to federate with.
What is the proposed name of the federation?
Please give details of the Governors' rationale for the federation including information on any potential impact to the local community.
Minute extract of Governors' discussion on proposal to federate.

Cancelof
Date of Governors' Resolution to federate.

DayMonthYear
Date
Governors' Resolution to federate.

Cancelof
Are the Local Authority aware of the federation?

YesNo
Evidence of LA discussions in support of the federation application.

Cancelof
Are the school community aware of the proposed federation?

YesNo
Head's Signature

Clear
Chair of Governor's Signature

Clear
Federation Application Date

DayMonthYear
Date

Change of Status (VC to VA)
Please give details of the Governors' rationale for the change of status request including information on any potential impact to the local community.
Minute extract of Governors' discussion on the proposed change of status.

Cancelof
Date of Governors' Resolution to the change of status.

DayMonthYear
Date
Governors' Resolution to change the status of the school.

Cancelof
Are the Local Authority aware of the change of status application?

YesNo
Evidence of LA discussions in support of the change of status application.

Cancelof
Are the school community aware of the proposed change of status?

YesNo
Head's Signature

Clear
Chair of Governor's Signature

Clear
Change of Status Application Date

DayMonthYear
Date

Multiple Site
Does the school currently operate across more than one site?

YesNo
Will the school operate under a single URN?

YesNo
Please provide the URN.
Will there be a change of name? .

Yes A separate Change of Name application will be requiredNo
Please provide the address of the main site.
Please provide the address of the additional site.
Is the additional site separated from the school's main site by road or railway?
Will children regularly be educated on both sites?
Have the governors identified who owns the additional site? Please provide details.
Please provide the governing body minutes resolving to explore operating on multiple sites.

Cancelof
Please provide the governing body minutes resolving to seek DBE approval.

Cancelof
Please provide evidence of support from the Local Authority.

Cancelof
Head's Signature

Clear
Chair of Governor's Signature

Clear
Multiple Site Application Date

DayMonthYear
Date

Seeking Change: Application for Diocesan Board of Education Approval