Form Fa-075 - Verification Of School Attendance Page 2
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3FA-075-FF (8-17)
Page 2 of 3
The following information is needed for extended Cash Assistance only:
Less than 90% School Attendance (Good Cause Reasons):
If any child(ren) have less than 90% attendance in the last full school quarter, is there a good cause reason for the child
being below 90% attendance?
Please check the box(es) below if any of the conditions apply:
The child’s physical or mental condition is such that either school attendance is prohibited or it is determined that school
is not in the child’s best interest.
The child has presented reasons to the public school for non-attendance that are satisfactory to the school principal or
the school’s designee.
The child is enrolled in a vocational, technical, career, or educational training program that meets the educational
standards established and approved by the Department of Education.
The child was suspended or expelled from a public school and the school has not directed the child to participate in an
alternative education program.
NAME OF SCHOOL OFFICIAL (Print)
TITLE
SCHOOL OFFICIAL’S SIGNATURE
DATE
NAME OF SCHOOL
ADDRESS (Street, No.)
CITY
STATE
ZIP CODE
PHONE NUMBER
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