MONTHLY SUMMARY OF SERVICES

Date Completed:
Service Month: / Actual Days of Service this Month:
School: / Principal:
PSA Counselor: / Service Days/Week:
PSA Coordinator: / Enrollment:
MONTHLY ACTIVITIES
UNIVERSAL
(PREVENTION)
(Macro strategies for absence and dropout prevention, teaching and reinforcing attendance)
Activity Description / *Date(s)
Hour (s)
(MM/DD/YY)
TARGETED
(GROUP INTERVENTION)
(Systems for early identification and intervention, re-teaching attendance, interventions for groups of students)
Activity Description / *Date(s)
Hour(s)
(MM/DD/YY)
INTENSIVE
(INDIVIDUAL INTERVENTION)
(Systems for identification and intervention of students who are at-risk for school failure and/or dropout)
Activity Description / *Date(s)
Hours(s)
(MM/DD/YY)
Date Completed:
Service Month: / Actual Days of Service this Month:
School: / Principal:
PSA Counselor: / Service Days/Week:
PSA Coordinator: / Enrollment:
Goal Area / Activity Description / Current Month / Cumulative To Date
# of Events / # of Participants / # of Events
Universal
(Prevention) / Recognitions
(Attendance/behavior awards, incentives, donations)
Collaboration/Assessment/Planning - Team meetings
(Participate in/facilitate Attendance team, COST, RCT, other school teams)
Informational Presentations/Professional Development
(Facilitate, coordinate and/or present on CWA topics e.g. attendance/dropout prevention, attendance accounting, classroom management and enrollment procedures; Large group, class presentations, school advisory groups, etc.)
Mass communications (attendance expectations)
(Written/oral/electronic/BlackBoard communications/announcements/assemblies about attendance expectations/absence prevention campaigns - targeted group or entire school)
Targeted
(Group Intervention) / Attendance Notification Letters
(Attendance letters sent e.g. Improvement, Warning, No-show, Not Enrolled, etc.)
Student Counseling/Skill Building Groups
(Small groups; single meetings or as part of a sequence- identifying and/or facilitating)
Targeted Groups/Informational Meetings
(Attendance Improvement meetings, credit recovery, parenting classes, workshops etc. single meetings or as part of a sequence)
Collaborative Consultation/Connecting Groups with Resources
(LAUSD/Non LAUSD personnel single or group meetings, e.g., Resource Fairs)
Intensive
( Individual Intervention)
( / Crisis Intervention/Threat Assessment
(Interventions or threat assessments, e.g. DCFS reports, school refusal)
Parent/Student Conferences (Non-SART)
(Conferences held in person, on the phone)
Multi-Disciplinary Groups/Consultation (Non-SART)
(Student Cases reviewed or discussed, e.g., SST, IEP, COST)
Resource Panel Case Presentations
(Case presentations/consultations) or (Cases taken to Resource Panel)
School Attendance Review Board (SARB) Case Presentations
(Cases presented to SARB)
Home Visits
(Home visits, address verifications conducted)
Individual Student/Family Referrals
(Students/families referred to alternative education, community school, agency, etc.)
Individual Assessment/Record Review/Counseling/Monitoring
(Intensive, individualized student support services and case management)
Student Attendance Review Team (SART) Current Month Tally
Kinder / Grade 1 / Grade 2 / Grade 3 / Grade 4 / Grade 5 / Grade 6 / Grade 7 / Grade 8 / Grade 9 / Grade 10 / Grade 11 / Grade 12 / TOTAL

Documents including but not limited to, potential dropout lists, monthly data profiles, meeting agendas, presentations, newsletters, flyers, parent/staff letters, memos, meeting sign-in sheets and Blackboard Connect reports are available for review upon request.

Revised 6.24.2015 2015-2016