Attendance/Academic Referral Form
* Required
Teacher Name
*
Your answer
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student ID
*
Your answer
Concern
*
Student has never logged in to Schoology/Khan Academy
Student has not logged in the last 5 days
Student is not completing expected amount of work
Other:
Required
Have you attempted contact
Phone call home
Emailed student
Emailed parent
Connect Ed
Remind Ap
Other
None
Other:
Results of Contact
Left voicemail/message
Number disconnected
Voicemail not set up
Spoke with parent/guardian
Spoke with student
Other:
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