500.16F3 RECOMMENDATION FOR REFERRAL TO COUNTY ATTORNEY FOR VIOLATION OF STATE MANDATORY ATTENDANCE LAW
RECOMMENDATION FOR REFERRAL TO COUNTY ATTORNEY
FOR VIOLATION OF STATE MANDATORY ATTENDANCE LAW
Date:_____________________ Referring Administrator: ____________________________
Name of Student: _____________________ DOB: _______ School: ___________ Grade Level: ______
Father’s Name: ______________________ Mother’s Name: _______________________
Address: __________________________ Address: ____________________________
__________________________ _____________________________
Phone: __________________________ Phone: _____________________________
*Total current school year full absences: _______
*Total current school year partial day absences: _______
*Total current school year tardies: _______
Previous year attendance issue(s) (optional): __________________________________ ______________________________________________________________________
______________________________________________________________________
The following attempts have been made by the school to notify the parent(s)/guardian(s) of concerns and attempt to resolve attendance concerns:
Dates of written notice to parent(s)/guardian(s): ____________________
Dates of phone contacts and individual initiating contact: ____________________
Dates of meetings at school and names of staff conducting the meeting: ______________
Dates of home visits and name of individual conducting visit: ________________________
Other interventions: __________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Other concerns (i.e. inadequate medical excuses). May include additional attachments:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Date: ________________________________
*Adopted: 11/14/16
*Revised: 11/11/19
*Reviewed: 07/17/23
