Truancy Intervention Panel Notes Form 2015-2016 Areas 1 & 2

Truancy Intervention Panel Notes Form 2015-2016 Areas 1 & 2
E-mail of person completing form:
Date of TIP:

MonthDayYear
Student ID#:
Student's Full Name:

First NameLast Name
Date of Birth (DOB):

MonthDayYear
Age:*
Gender:*

MaleFemale
Race/Ethnicity:*
School:*
Grade:*
Total Number of Absences:
Total Number of Unexcused Absences:
Total Number of Excused Absences:
Total Number of Tardies:
When concerns occured:
Presenting Issues:

MedicalAcademicMental HealthFinancialEmotionalBullying/TeasingBehaviorFamily Vacation
Type of Contact:
School Attendees:*

School Social Worker (SSW)Truancy CoordinatorCommunity Outreach OfficerPrincipalAssistant PrincipalAdministratorProfessional CounselorCommunity MemberCampus OfficerSSW InternTeacherSSW (Supervisor)- ObservationSchool NurseOther
If "other" was checked in last question please explain:
Student/Family Present for TIP:

MotherFatherSisterBrotherGrandmotherGrandfatherAuntUncleStudentCousinStepmotherStepfatherNeighborFriend of Family
Comments/Notes:
Panel Recommendations:

Attendance ContractJuvenile Court ComplaintTutoringIntensive Family Intervention (IFI)Monitor AttendanceCase Management by SSWCase Management by Truancy CoordinatorGroupClub/SportsNurse PlanMake doctors appointmentFollow-up with Medicaid ApplicationProvide Medical DocumenationOther
If "other" was chosen for the above question please explain:
Attendance Policy & Law:

The GA Compulsory Attendance Law & Cobb County County School District Attendance Policy was explained to ParentThe GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to StudentThe GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to Parent & StudentThe GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to and signed by parentThe GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to and signed by studentThe GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained and signed by student and parent
Should be Empty: