TEMPLATE - Attendance Form (v2 pilot)

1
Your Name* This field is required.Please enter your first and last name.
First Name
Last Name
2
EmailPlease enter your email address.
example@example.com
3
Phone NumberPlease provide the best number to reach you.
4
Student 1 Name* This field is required.Please enter your student's name.
First Name
Last Name
5
Student 2 Name (Optional)If applicable, please enter your second student's name.
First Name
Last Name
6
Student 3 Name (Optional)If applicable, please enter your third student's name.
First Name
Last Name
7
Will student be absent or tardy?Please let us know if your student(s) will be absent or tardy.
Absent
Tardy
8
First date student will be absent or tardy* This field is required.If your student will be tardy, please let us know on what date. If they will be absent, please let us know the first date of their absence.
Date
Month
Day
Year
9
Last date student will be absentWhen will be the last date of your student's absence?
Date
Month
Day
Year
10
Reason for absence/tardyWhy will your child be absent or tardy?
Holiday
Doctor Appointment
Illness (Health or Mental Health Issues)
Money Issues
Transportation Issues
Housing Issues
Work Reasons
Care (Child or Adult)
Other
11
Please share more details regarding selection so we may support you.
Addiction and Recovery
Dental Care
End of Life Care
Transportation for Healthcare
Paying for Healthcare
Other
12
DocumentationPlease attach any additional documentation you have to verify the reason for your student's tardiness or absence (e.g. doctor's note, etc.). If none, select Submit at the bottom of the page.
Drag and drop files here
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Max. file size: 10.6MB
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