ATD Student Referral Form

Step 1 Instructions:

The information provided in this section of the truancy referral is to provide us with the contact information for the person that is submitting the truancy referral.

Person referring

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The following email address will be used to send link to the application form:

Secondary Contact Person

In this section, please let us know if there is someone that you would like us to contact directly for attendance update requests. This section is not required, but is helpful.

District and School Information

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Step 2 Instructions:

The information provided in this section is to primarily provide the demographic background of the student. It is also to provide us with the proper contact information for the parents and or guardians.

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We ask this question because juvenile delinquency charges supersede truancy. If they are currently court involved (not including municipal or family court), this may change services that ATD can provide.

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9 Digit Number: No dashes or spaces

 

SIS #: The State Identification number is a 9 digit unique number issued in IWAS by ISBE. Please note: this is not the District Id number. SIS numbers will not contain the year that the student is anticipated to graduate from high school, and will not have three or more consecutive zero's. If you are unaware of where to locate the SIS number, please contact someone in your IT department, or front office.

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Student Address

 

Please enter any secondary address on record for another custodial parent and/or guardian.

Primary Parent/Guardian

Secondary Parent/Guardian

Who Does the Student Live With

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Current Year Attendance

Please enter the data based on the current school year. The Date Enrolled is also referring to this school year. That helps us to see if they enrolled on time or not. The attendance reported should be in full and half day increments (not by class periods). Due to ISBE reporting, our database will round to the nearest whole number.

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History of Absence by Grade

Please review the cumulative file to locate the history of absences for the student and enter the data below. This information is required. Entering a "0" will initiate a request from ATD after the referral for the missing information (unless it is a grade they haven't entered yet). Please provide a note in the "comment section" of why you are unable to provide this information.

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High School Credit Information

Total Required to Graduate Refers to the whole 4 years required. Examples of local schools would be: 22, 23, 22.5, 41.

Earned YTD

Refers to the number of credits that they have earned so far in their High School career.

Attempting

Refers to the total number of credits the student is attempting right now, as you are completing the truancy referral.

Attempts the school has made to remedy the attendance problem:

The Illinois School Code requires schools to take measures to assist the student and his/her family in resolving attendance issues. Documentation of these interventions is necessary (dates, description).

Barriers to Attendance

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Required