Request to Locate/Engage Student

Regional Office of Education 1 Stuart Drive Kankakee, Illinois

815-937-2952 - FAX 815-937-2921
STUDENT/FAMILY ENGAGEMENT REQUEST FOR ASSISTANCE
Todays Date

MonthDayYear
Date
Student Name
School Building
Grade
Last Attendance or Engagement Date

MonthDayYear
Date
Last Known Address
Parent/Guardian Name
Phone Number
Format: (000) 000-0000.
Emergency Contact
First and Last Name
Emergency Contact Phone Number
Format: (000) 000-0000.
School Attempts To Contact Student/Parent
(1) Phone call made to: Name and Relationship:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
on date

MonthDayYear
Date
Time:
Outcome
(2) Phone call made to: Name and relationship:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
on date

MonthDayYear
Date
at Time:
Outcome
Home visit made by: (name of school staff)
Date

MonthDayYear
Date
Time visit occurred:
Outcome
Other Notes or Information regarding student, siblings, family
Attendance Assistance Caseworker
Should be Empty:

STUDENT/FAMILY ENGAGEMENT REQUEST FOR ASSISTANCE