Student Attendance Intervention Plan Page 2
ADVERTISEMENT
1
2
3
4Special Education Teacher (if applicable):
Psychologist:
Other:
1.
School Refusal Assessments Scale Completed
Parent
Child
2.
What is the nature of the student’s attendance problem? (please check all that apply)
Transportation Issue
Safety Issue
Health Issue
Too far to go
Surrounding
Pregnancy
No money for
neighborhood not safe
Lacking medical
transportation
School not safe
care/immunizations
No reliable means of
Gangs
Medical problems
getting to school
School Problem
Substance abuse
Academic/School Issue
Disability
Problems with teach or
Home Issue
Mental illness
other school personnel
Tending to younger
Poor academic
siblings
performance
Parent/Guardian not
School discipline
well
Suspended from school
Physical/sexual abuse
Other:
Social Issue
in the home
Gender Intimidation
Substance abuse in the
Gang Activity
home
Financial Issues
Homeless
Difficult peer
Domestic violence
relationships
Runaway
Bullying
Date violence
Personal Relationships
Neglect
Student is also a parent
Student Characteristics:
Low Achievement
Low Attendance
High Failure Rate
Parenthood
Credit Deficiencies
Discipline Referral
Drug/Alcohol Problem
Health-Related Issues
Other: ____________
Please specify the details of the attendance problems(s) checked above and describe any
applicable problems no listed above:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business