3040F2: Compulsory Attendance Prosecutor Referral Form

Gooding Joint School District No. 231

STUDENTS 3040F2

SCHOOL TRUANCY REFERRAL FORM PART I:

Student

(last name) (first name) (middle name)

Grade Age DOB Sex Race Language

Mother’s Name Phone Wk Phone

Mother’s Address City Zip DOB

Father’s Name Phone Wk Phone

Father’s Address City Zip DOB

Child resides with _

Address (if different than above) Zip Phone

PART II:

Enrollment Date: Number of Tardies:

Number of Absences without Valid Excuse: Number of Absences with Valid Excuse: Dates Child was Absent from School without Valid Excuse:

Suspension/Expulsion Dates:

Contacts with Parents, Actions Taken, and Outcomes (attach additional sheets if necessary):

Date: Date: Date: Date:

Advisory Letter Sent? No

Yes

Date:

School Representative (person who can testify to the identification of the child, enrollment, keeping of records, and content of records):

PART III: REFERRING SCHOOL INFORMATION

School Name Address City & State

District Telephone Zip



 

Print name of person submitting report Title and Position

Phone Signature

Transcript Request Form

Please initial below to acknowledge that you are the student named above and that you have reviewed the information above and agree that it is accurate. By initialing below you endorse this document as legally binding in accordance with the e-sign bill S.761 and release the below initials in lieu of a signature.
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