ROE#21 Truancy Referral Form FY21
The Truancy Referral should be submitted by the school when a student has accumulated 5% unexcused absences calculated from the total number of student attendance days. Submission of the Truancy Referral will initiate Step One of the Partners Against Chronic Truancy (PACT) Program.
County of Referring District *
Referring School Name *
Name of Staff Member Referring Student
Enter your name
Referring Party's Position
Enter your position
Referring Party's Email *
Referring Party's Phone Number
Teacher's Name
(Elementary Only)
Teacher's Email Address
(Elementary Only)
Next
Never submit passwords through Google Forms.
This form was created inside of Regional Office of Education #21. Report Abuse