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*
Emergency Contact
First and Last Name
Emergency Contact Phone Number*
School Attempts To Contact Student/Parent
(1) Phone call made to: Name and Relationship:*
Phone Number
Please enter a valid phone number.
on date

MonthDayYear
Date
Time:
Outcome*
(2) Phone call made to: Name and relationship:*
Phone Number*
Please enter a valid phone number.
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