Macon-Piatt Regional Office of Education

Macon-Piatt Regional Office of Education

Report of Noncompliance With School Attendance Law Referral for Truancy

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District # / School
Name
/ Male / / Female / Truant’s Birth Date / Grade in School
Home Address
City / Zip / Telephone No.
Guardian Name / Relationship
Occupation / Telephone No.
Address
Guardian Name / Relationship
Occupation / Telephone No.
Address
Parents’ Marital Status
If divorced or separated, who has legal custody?
Brother’s and/or Sister’s Name(s)

Student lives with: (Please place an X in proper box.)

/ 1. Both parents / / 2. Mother & Stepfather / / 3. Father & Stepmother
/ 4. Mother Only / / 5. Father Only / / 6. Foster Home
/ 7. Grandparent(s) / / 8. Other

Please indicate the chronic truancy referral source:

Truancy Review Board Referral for Non-Compliance and Chronic Truancy

Unsuccessful termination from State’s Attorney’s Office Truancy Court Diversion Program

School District Non-Compliance Referral for chronic truancy

ALL chronic truancy referrals must include:

Two individuals who can identify both the parent and student:

Name:
Title/Position:
Work Address:
Home Address:
Work Phone: / Home Phone:
Name:
Title/Position:
Work Address:
Home Address:
Work Phone: / Home Phone:

Chronic Truant Attendance Reports

ROE 39 Truant Officer Summary Statement

Building Principal or Designee Statement

Student Evaluation Form (to be completed by each of the student’s teachers)

Please include statements from all persons involved in case development

Agency or Occupation / Name of Individual / Agency or Occupation / Name of Individual
/ 1. Secretary / / 7. Futures Unlimited
/ 2. School Counselor / / 8. Probation
/ 3. School Nurse / / 9. D.C.F.S.
/ 4. Principal/Dean / / 10. Youth Services
/ 5. Attendance Officer / / 11. Mental Health
/ 6. Outreach Worker / / 12. Other

School District Proof of Contact:

Proof of parent notification letter for three (3) unexcused absences

Proof of parent notification letter for five (5) unexcused absences

Proof of parent notification letter for nine (9) unexcused absences

Documentation of supportive services, alternative programs, and other school resources that were provided in efforts to correct the student’s truant behavior (105 ILCS 5/26-8a) must be provided by the designated school district.All must include signatures, legible and detailed descriptions, and dates of provided services (which may include but are not limited to):

Student/Family Information

He/She is now a ward of the Court:

If yes, name of department and probation officer or case worker
Year / Present / Truant / Excused / Suspensions
August
September
October
November
December
January
February
March
April
May
June
July
Total

Form Completed By:

Name Printed
Title / Phone No.
Signature / Date