Regional Office of Education #9 CHAMPAIGN-FORD COUNTIES Attendance Improvement Program (AIP) Referral
Please complete the referral for Truant minor. After submitting this form, please submit a copy of the most recent Attendance Report. Student must have a minimum of 5 Unexcused Absences. Email Attendance Report to Kim Nix, Attendance Improvement Specialist at roe9attendance@gmail.com. To contact Kim directly, you may call 217-239-0322 or email knix@roe9.k12.il.us.
STUDENT INFORMATION
Please provide all the student's information below.
Date of Referral: *
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Last Name *
Your answer
First Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Date of Birth *
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State ID # *
Your answer
Educational Status *
If Special Education, please indicate disability and services.
Your answer
Gender *
Race *
Primary language spoken in the home *
Home School *
Current Grade in school *
Total Credits Needed to Graduate High School (if not in HS, do not need to complete)
Your answer
Current School Year: # of Days Possible (up to referral date): *
Your answer
Current School Year: # of Excused Absences *
Your answer
Current School Year: # of Unexcused Absences *
Your answer
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