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:

Month Day Year
Student ID#:
Student's Full Name:

First Name Last Name
Date of Birth (DOB):

Month Day Year
Age: *
Gender: *

Male Female
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:

Medical Academic Mental Health Financial Emotional Bullying/Teasing Behavior Family Vacation
Type of Contact:
School Attendees: *

School Social Worker (SSW) Truancy Coordinator Community Outreach Officer Principal Assistant Principal Administrator Professional Counselor Community Member Campus Officer SSW Intern Teacher SSW (Supervisor)- Observation School Nurse Other
If "other" was checked in last question please explain:
Student/Family Present for TIP:

Mother Father Sister Brother Grandmother Grandfather Aunt Uncle Student Cousin Stepmother Stepfather Neighbor Friend of Family
Comments/Notes:
Panel Recommendations:

Attendance Contract Juvenile Court Complaint Tutoring Intensive Family Intervention (IFI) Monitor Attendance Case Management by SSW Case Management by Truancy Coordinator Group Club/Sports Nurse Plan Make doctors appointment Follow-up with Medicaid Application Provide Medical Documenation Other
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 Parent The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to Student The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to Parent & Student The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to and signed by parent The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to and signed by student The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained and signed by student and parent
Should be Empty: