Student Attendance Intervention Plan

Student Attendance Intervention Plan
NAME OF STUDENT:______________________________ Date of Birth:___________
School:__________________________________________ Present Grade:_________
Parent(s)/ Guardian(s):___________________________________________________
Street Address:_________________________________________________________
Mailing Address (if different):_______________________________________________
Telephone Numbers: (H)______________, (W)_____________, (Emer)_____________
Student’s Attendance History (days absent, past problems, previous schools, etc.)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Record of Conference
Conference Date:_________________________
Total Absences_____ ( ___excused ____unexcused) as of_______________________
Individuals Present at Conference:_________________________________________
_______________________________________________________________________
_______________________________________________________________________
(Parent/Guardian and student above the age of 12 must be in attendance at intervention
conference.)
Reasons given for unlawful absences (specify date and reason for each unlawful absence):
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Actions to be taken by Parent/Guardian and student to resolve causes of unlawful
absences:
a.________________________________________________________________________
b.________________________________________________________________________
c.________________________________________________________________________
Results of Actions taken by Parent/Guardian and student to resolve causes of unlawful
absences: (to be documented as results occur)
a._________________________________________________________________________
b._________________________________________________________________________
c._________________________________________________________________________
Actions to be taken by School Personnel:
a._________________________________________________________________________
b._________________________________________________________________________
c._________________________________________________________________________
Results of Actions taken by School Personnel: (to be documented as results occur)
a._________________________________________________________________________
b._________________________________________________________________________
c._________________________________________________________________________
Additional Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
________________________
School Personnel
______________________________
Student’s Signature
_______________________________
Parent’s/Guardian’s Signature
_______________________________
Parent’s/Guardian’s Signature