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.
* Required
County of Referring District
*
Choose
Franklin <franklincountytruancy@roe21.org>
Johnson <johnsoncountytruancy@roe21.org>
Massac <massaccountytruancy@roe21.org>
Williamson <williamsoncountytruancy@roe21.org>
Referring School Name
*
Choose
Adams School #2
Akin Comm Cons Elem School #91
Benton Cons High School #103
Benton Grade Sch 5-8 #47
Benton Grade Sch K-4 #47
Brookport Elementary School #1
Buncombe Cons School #43
Carterville High School #5
Carterville Intermediate Sch #5
Carterville Jr High Sch #5
Central Jr High School #168
Christopher Elem School #99
Christopher High #99
Crab Orchard Elementary School #3
Crab Orchard High School #3
Cypress Elem School #64
Denning Elementary School #168
Ewing-Northern Elem School #115
Frankfort Community High School #168
Frankfort Intermediate School #168
Franklin Elem School (Massac) #1
Goreville Elementary School #1
Goreville High School #1
Herrin C U S D 4 Elem School #4
Herrin High School #4
Herrin Middle School #4
Jefferson Elem School (Massac) #1
Jefferson Elem School (JC) #1
Jefferson Elem School (Marion) #2
Johnston City High School #1
Joppa Jr & Sr High School #38
Lincoln Elem School (JC) #1
Lincoln Elem School (Marion) #2
Longfellow Elem School #2
Maple Grove Elem School #38
Marion High School #2
Marion Jr High School #2
Massac County High School #1
Massac Jr High School #1
Metropolis Elem School #1
New Simpson Hill Dist 32 #32
North Side Primary Center #4
Sesser-Valier Elem School #196
Sesser-Valier High School #196
Sesser-Valier Jr High School #196
Thompsonville Grade School #174
Thompsonville High School #174
Tri-C Elementary School #5
Unity Elem School (Massac) #1
Vienna Elem School Dist #55
Vienna High School #133
Washington Elem School (Marion) #2
Washington Middle School (JC) #1
Zeigler-Royalton Elem School #188
Zeigler-Royalton High School #188
Zeigler-Royalton Jr High School #188
Name of Staff Member Referring Student
Enter your name
Your answer
Referring Party's Position
Enter your position
Your answer
Referring Party's Email
*
Your answer
Referring Party's Phone Number
Your answer
Teacher's Name
(Elementary Only)
Your answer
Teacher's Email Address
(Elementary Only)
Your answer
Next
Never submit passwords through Google Forms.
This form was created inside of Regional Office of Education #21.
Report Abuse
Forms
