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REFERRAL TO THE
SCHOOL ATTENDANCE REVIEW BOARD (SARB)
PAGE 1 OF 2

|  Date of Referral: 7/21/2011  |  Referring Person: Paulson, Pat  |  School: Granada Elementary  |

 

Student Demographics

 

Name:       Portia

DOB: XX/XX/1998 |DID: XXXXXXXX SSID: xxxxxxxxxx  GR: 07 |GN: Female |SpEd: Yes |ETH: Asian

Lives with Father only |Father:                                   |Mother:       

PMT: NO |Address:                                          Los Angeles, CA 90032-2044

Home Phone: xxx xxx-xxxx |Father Phone: xxx xxx-xxxx |Mother Phone: xxx xxx-xxxx

FLN: RFEP |504: YES |ACAD: None |CAHSEE: Math: None Date: None ELA: None Date: None

 

IS OR HAS STUDENT:

 

  checkbox YES | checkbox NO—On Probation   If YES, name of DPO: whitebox lftwhite boxwhite boxwhite boxwhiteboxrt

  checkbox YES | checkbox NO—Been referred to SARB before   If YES, (Date/District): whitebox lftwhite boxwhite boxwhite boxwhiteboxrt

 

CHECK PRIOR ATTEMPS AT REMEDIATION

checkbox Attendance contract/monitoring process (attach copy)

checkbox Behavior contract

checkbox Conference was held with student and parent.

checkbox Disciplinary Action taken
        checkbox Detention (recess, before school, after school)
        checkbox Saturday School and student   checkbox attended   checkbox did not attend

checkbox Referrals made to
        checkbox Counseling, off-site (agency, program name) whitebox lftwhite boxwhite boxwhite boxwhiteboxrt
        checkbox Counseling, on-site
        checkbox Home-school coordinator
        checkbox Nurse
        checkbox Peer (buddy, counselor, supporter)

 

CHECK AND ATTACH A COPY OF THE FOLLOWING DOCUMENTS WITH THIS REFERRAL

checkbox First Notification of Truancy letter

checkbox Second Notification of Truancy letter

checkbox Summary of Meeting with the School Attendance Review Team

checkbox Attendance report showing date of SART Meeting

checkbox Elementary-latest report card and test results

checkbox Secondary-latest report card, test results, and transcript

checkbox Student Demographics from Powerschool


Include a brief summary of the problem:

 

 


REFERRAL TO THE
SCHOOL ATTENDANCE REVIEW BOARD (SARB)
PAGE 2 OF 2

|  ID:  Last Name, First  |

Table

The First Letter of Notification of Truancy was sent to parent after the student had these unexcused absences:

Unexcused Absence block 1

The Second Letter of Notification of Truancy was sent to parent after the student had these unexcused absences:

Excused Absence form 2

After the parent met with the School Attendance Review Team (SART), the student had these unexcused absences:

Unexcused Absences form 3