Roosevelt Middle School Attendance Verification/ Notificacion de Ausencia
You can use this form to report your child's absence from Roosevelt Middle School. By completing and submitting this form, you are authorizing Roosevelt Middle School to note the absence of your child today, and you hereby give consent that telephone verification may be required by the school. If you have multiple students who attend Roosevelt Middle School and who will be absent, you must complete this form for each child.

Note: This form is NOT for early dismissals or homework requests. For homework requests, please contact your child's teacher via email. Thank you.

Please be specific about the reason why your child will not be attending school today. In the "Reason for Absence/Late Arrival" blank space on the form below, indicate whether your child has any of the following symptoms:
-Feeling feverish or chills
-Fever greater than or equal to 100.4 F
-Headache (not due to another health condition, hunger, menstrual cramps stress, or injury)
-A new cough (not due to another health condition)
-Shortness of breath or breathing difficulties (not due to diagnosed respiratory condition or if different than the
normal pattern of a chronic condition)
-A new sore throat (not due to another health condition)
-Congestion or runny nose (not related to allergies or health condition)
-Fatigue (more tired than normal or sudden onset)
-New muscle pain (not due to another health condition or that may have been caused by a specific activity such as physical exercise)
-New loss of taste, smell, or appetite
-Abdominal pain (not due to hunger, constipation, injury, or stress)
-Nausea, vomiting, or diarrhea

This attendance form is to be submitted by the parent/legal guardian only.

Any absence not cleared and verified by this form and/or a phone call within 5 days becomes an unexcused absence. Students with excessive absences (illness, excused, unexcused, truancy) may be required to attend our Saturday Core Academy to make up lost instructional time.

Students who will be absent from school for 3 or more days (including the need to quarantine) should obtain a Contract for Independent Study from the Attendance Office and will be expected to follow along with their coursework asynchronously via google classrooms.

Usted puede usar este formulario para reportar a su estudiante cuando este ausente de la escuela Roosevelt. Al llenar y mandar este formulario, usted esta autorizando a la escuela secundaria Roosevelt anotar a su estudiante ausente y tambien usted estara dando consentimiento para que se verifique de ser ser necesario hablarle por telefono por parte de la escuela. Si usted tiene mas de un estudiante en Roosevelt, y que estara ausente, usted debera llenar una forma separada para cada estudiante.
NOTA: Esta forma NO es para solicitar que su estudiante salga temprano ni para solicitar tarea. Para solicitar tarea, por favor pongase en contacto con los maestros de su estudiante por medio de correo electronico. ¡Gracias!
Al reportar a su estudiante enfermo, por favor sea especifico sobre la razon de la ausencia el dia de hoy. Donde vea la pregunta sobre la razon de la ausencia o llegada tarde, en el cuadro en blanco, indique si su estudiante tiene los siguientes sintomas: calentura, o escalofrios, calentura mas de 100.4, dolor de cabeza (no relacionado con otra condicion de salud, hambre, colicos, estress, o lastimaduras), tiene dificultad para respirar (que no sea relacionado con una condicion respiratoria o que sea diferente a un patron normal de una condicion cronica), dolor de garganta nuevo (que no sea relacionado con otra condicion de salud), cansancio o fatiga (mas de lo normal), dolor de huesos reciente, perdida de olor, sabor, o apetito reciente, dolor abdominal (no relacionado con hambre, estress, etc), nausea, vomito, o diarrhea
Este formulario debera ser llenado solo por uno de los padres de familia o guardian legal. Ausencias que no sean justificadas por este formulario o una llamada telefonica, dentro de 5 dias sera una falta injustificada. Los estudiantes con faltas excesivas y que no sean por enfermedad, justificadas, injustificadas, se les podra requerir que asistan a la escuela del sabado para reponer asistencia.
A los estudiantes que estaran ausentes por mas de 3 dias a causa e incluyendo la necesidad de hacer quarentena, deberan pedir un contrato de la oficina de asistencia. Si su estudiante tiene un contrato, el estudiante debe hacer el trabajo asignado dentro de cada clase por medio de google classroom.
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Student Name/Nombre del estudiante *
Student ID/numero de identification de estudiante
Date of absence/fecha de la ausencia *
MM
/
DD
/
YYYY
Reason for Absence/razon de la ausencia *
Parent/Guardian First & Last Name/Nombre del padre o guardian *
Parent/Guardian Email address (must match email address in PowerSchool)/Correo electronico del padre o guardian *
Parent/Guardian phone number (must match phone number in PowerSchool)/Numero de telefono del padre o guardian *
Do you confirm that that you are the parent or legal guardian of the student/Usted confirma que usted es el padre/madre/ o guardian del estudiante? *
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