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LCPS FORM JHB-E1

STUDENT ATTENDANCE INTERVENTION PLAN


The purpose of the Student Attendance Intervention Plan is to identify the reason(s) for a
students truancy, document the previous steps taken by the school to address the students
truancy problem, and develop the plans necessary to improve the students future attendance.
Conference Date:
Identification Information
Students Name:

Grade:

Pupil ID#:
Date of Birth:

Age:

School:

Address:

City:

Zip:

Fathers Name:

Mothers Name:

Legal Guardians Name:


Parent/Guardians Primary Language:

English

Spanish

Other:

Students Primary Language:

English

Spanish

Other:

Phone Numbers (include student [if available], parent [cell, work, home], other relatives as
necessary, emergency):
Email address:
Sibling name:
School:
Sibling name:
School:
Sibling name:
School:
Sibling name:
School:
Sibling name:
School:
Sibling name:
School:

ID#:
DOB:
ID#:
DOB:
ID#:
DOB:
ID#:
DOB:
ID#:
DOB:
ID#:
DOB:

DRAFT: JHB-E1: Students in Need of Early Intervention for Attendance,

Revised 08.07.13

Student Attendance History (Days absent, past problems, previous schools, etc.)

New Mexico law requires schools to take measures to assist the student and family in resolving
an attendance problem. Documentation of these interventions is necessary and should include
dates and comments. The following school personnel were utilized in the intervention process:
Designated Intervention Team Leaders:
Attendance and Student Services:
Parent/Guardian (1):
Parent/Guardian (2):
Teacher(s):
Social Worker:
Counselor:
School Administration:
Other:

DRAFT: JHB-E1: Students in Need of Early Intervention for Attendance,

Revised 08.07.13

STUDENT ATTENDANCE INTERVENTION PLAN


1. What is the nature of the students attendance problem? (check all that apply)

Transportation Issue
Too far to go
No money for transportation

Safety Issue

Health Issue

Surrounding neighborhood

Pregnancy

not safe

No reliable means of getting to

Lacking medical

School not safe

school

Academic/School Issue
Problems with teacher or

Gangs

Medical problems

School problem

Substance abuse

Home Issue

other school personnel

Tending to younger siblings

Poor academic performance

care/immunizations

Disability
Mental illness
School refusal

Parent/guardian not well

School discipline

Physical/sexual abuse in

Suspended from school

Other (specify)

the home

Social Issue

Substance abuse in the home

Gender intimidation

Homeless

Gang activity

Neglect

Financial issues

Student is also a parent

Difficult peer relationships

Runaway

Bullying

Family dynamics

Personal relationships

Student Characteristics
Low achievement

Parenthood

Low attendance

High failure rate

Drug/alcohol problem

Credit deficiencies

Discipline referral

Health-related issues

Other:

Specify the details of the attendance problem(s) checked above and describe any applicable
problems not listed above:
2. Collaborative recommendations of the student, parent/guardian and school personnel to
solve the attendance problem:
3. Referred to social service agency (name):
Student counseling

Parent training

Parent counseling

Alternative placement

Student evaluation

Other:

Medical evaluation

DRAFT: JHB-E1: Students in Need of Early Intervention for Attendance,

Revised 08.07.13

4. Actions to be taken by parent/guardian(s) to resolve causes of unlawful absences:


The parent will make sure that the student is up and prepared for school each day.
The parent will make sure that the student has transportation to and from school each day.
The parent will send written and/or medical excuses when student is absent for valid reason.
The parent will notify the school by written note when the student is absent.
Other:
5. Actions to be taken by the student to resolve the causes of the unlawful absences:
The student will take all necessary steps to ensure that he/she is awake, ready for school and at
school, on time every day.
The student will attend school daily and be absent only for lawful reasons.
The student will provide written and/or medical excuses for all lawful absences.
The student has signed the attendance intervention plan.
Other:
6. Actions to be taken by intervention team members:
Develop an Attendance Intervention Plan.
Monitor students attendance at school.
Review and update the Attendance Intervention Plan as appropriate.
Refer student to school administration for additional follow-up by district attendance official.
Other:
7. Actions to be taken in the event unlawful absences continue:
School officials will review and update the Attendance Intervention Plan.
School officials will contact parents by letter, phone or e-mail to notify them of the
continued absences.
School officials will refer student to district attendance official for continued non-attendance.
Student will be referred to the appropriate outside agency (JPPO/DA/CPS) for intervention.
Other:
8. The next meeting to review the progress of attendance improvement recommendations
will be held:

DRAFT: JHB-E1: Students in Need of Early Intervention for Attendance,

Revised 08.07.13

9. Signatures:
_______________________________________________

_______________________________________________

Student name (please print)

Parent/guardian name (please print)

________________________________________________

_______________________________________________

Student signature

Parent/guardian signature

Date:

Date:

_______________________________________________

_______________________________________________

LCPS Attendance Official signature

Print parent/guardian name (please print)


_______________________________________________
Parent/Guardian Signature

Date:

Date:

10. Parent attended Attendance Intervention Plan conference?

Yes

No

Conference Contact Documentation


1st attempt to contact parent/guardian.

Successful?

Yes

No

Yes

No

Date:
Person/Title Who Initiated Contact:
Phone call
Letter

Certified Letter

In-Person

e-Mail

Other:

Additional Information:

2nd attempt to contact parent/guardian.

Successful?

Date:
Person/Title Who Initiated Contact:
Phone call
Letter

Certified Letter

In-Person

e-Mail

Other:

Additional Information:

DRAFT: JHB-E1: Students in Need of Early Intervention for Attendance,

Revised 08.07.13

3rd attempt to contact parent/guardian.

Successful?

Yes

No

Yes

No

Yes

No

Yes

No

Date:
Person/Title Who Initiated Contact:
Phone call
Letter

Certified Letter

In-Person

e-Mail

Other:

Additional Information:

4th attempt to contact parent/guardian.

Successful?

Date:
Person/Title Who Initiated Contact:
Phone call
Letter

Certified Letter

In-Person

e-Mail

Other:

Additional Information:

5th attempt to contact parent/guardian.

Successful?

Date:
Person/Title Who Initiated Contact:
Phone call
Letter

Certified Letter

In-Person

e-Mail

Other:

Additional Information:

6th attempt to contact parent/guardian.

Successful?

Date:
Person/Title Who Initiated Contact:
Phone call
Letter

Certified Letter

In-Person

e-Mail

Other:

Additional Information:

DRAFT: JHB-E1: Students in Need of Early Intervention for Attendance,

Revised 08.07.13