School Attendance Review Board

SCHOOL ATTENDANCE REVIEW BOARD
APPLICATION FOR SARB HEARING
AREA: o CENTRAL o CORCORAN o HANFORD o LEMOORE o REEF SUNSET
Mailing Address: C/O Kings County Office of Education
1144 West Lacey Boulevard
Hanford, California 93230
INSTRUCTIONS:
Application for a SARB hearing should be submitted only after local efforts to solve the problem have been to no avail. Specific local efforts must be documented in the appropriate sections of this application. Submit one (1) copy to local SARB; retain one (1) copy; route additional copies in accordance with district policy.
NOTE: Referring district official or designated representative must appear at time of SARB hearing. Parent or
guardian must be notified personally by district representative and invited to attend with minor.
IT IS HEREBY ALLEGED THAT / , a minor, comes under Section 601.1
W&I Code in that:
o Said minor is habitually truant or irregular in attendance.
o Said minor is insubordinate or disorderly and is beyond control of the school authorities.
Signature / Date
Name and Title (Please Print)
PART I - IDENTIFYING DATA
Name of Minor: / DOB: / Age: / Sex: / M o F o
Address/City/Zip: / Grade:
Ethnicity: / Phone:
Father/Stepfather: / DOB: / Phone:
Address/City/Zip:
Mailing Address:
Mother/Stepmother: / DOB: / Phone:
Address/City/Zip:
Mailing Address:
Guardian: / DOB: / Phone:
Address/City/Zip:
Mailing Address:
Siblings in Home:
District of student referred to SARB: / School:
PART II - VERIFICATION, HABITUALLY TRUANT (E.C. 48262)
(Must be within one school year)
1. / Said minor was reported as a truant due to absence from school three or more days to wit:
1st / 2nd / 3rd
Other
School Action: / 1st Truancy Letter / By Whom:
Date:
2. / Having thus been reported as a truant, the subject was again absent from school without valid excuse one or more
days to wit, and was again reported as a truant:
School Action: / 2nd Truancy Letter / By Whom:
Date:
3. / Subsequent to the above dates the subject was again absent from school without valid excuse one or more days to
wit, and was again reported as a truant:
A conscientious effort was made to hold at least one conference with the parent or guardian and minor. Minor is
therefore deemed a habitual truant.
School Action: / 3rd Truancy Letter / By Whom:
Date:
Summary:
Days Enrolled: / Days Present: / Period Cuts:
Days Absent Excused: / Days Absent Unexcused:
Days Tardy over 30: / Days Suspended:
REFERRALS TO OTHER AGENCIES (Optional)
Date: / Agency: / Results:
Probation Dept. / Probation Status:
Welfare Dept.
Guidance Services
Other:
Recommended Action: