Reporting Form for Absenteeism Over 20%

Edited for Jolene Bracale by Don Gilroy on 02/21/2023.
Reporting Form for Absenteeism Over 20%
Name of School:
Name of School Corporation:
County
Date:

MonthDayYear
Total Number of Students Enrolled in School:
Total Number of Students Absent:
Known Diagnosis:

Other
Local Health Department has been Notified:
Plan of Action - School Will:
Title of Person Completing Report
Should be Empty: