Excessive Student Absence Document - Exhibit Q Student: Date of Birth: Date: Date of last IEP: District of Residence: Date of First Contact with District: District Contact: Contact Method: Phone in Person □ □ □ Attendance Record Total number of absence days: – August September October November □ □ □ □ December January February March □ □ □ □ May June July □ □ □ □ Overview of Absences: Interventions Implemented/Outcomes: (ie: SARB, Counseling, District/Agency/Parent meetings, etc.) Signatures: Print Name: Signature:
Excessive Student Absence Document - Exhibit Q Student: Date of Birth: Date: Date of last IEP: District of Residence: Date of First Contact with District: District Contact: Contact Method: □ Phone □ □ in Person Attendance Record – Total number of absence days: □ August □ September □ October □ November □ December □ January □ February □ March □ □ May □ June □ July Overview of Absences: Interventions Implemented/Outcomes: (ie: SARB, Counseling, District/Agency/Parent meetings, etc.) Signatures: Print Name: Signature:
1_Exhibit_Q_16-17.docx