WPC2 =/zVV.])EL#pXr֘5fM "e(\Ѣ֋ΊShMЎΟ݈"VUOUѣ]b_ L;Wx}N8~Hs ]|u .Zyzxag>A /#CO#ZzH*O{a_,c9F:ήNNs+x:9ɚ 0yNI~z+^ب)|J{a%`-g"B󃆰-QMk?۪Iȥ`8ŕLIYHIH;y)0v6H~+pi4yHp sKҸo虳r6E>\vj_m`4l531leLFͤia"ҡF+Z1x4{UP?Zq\#UN % 0:% ^ _ wk 4o   m U< 1 fn ap f a f a f a f a f a E f a f f a a" 6 0V U0 72O 1u 72 0c( 1 72ND 1F 72fa BSAVIN 2055DP PCL 60(9 Z6Times New Roman RegularX($USUS.,, L,(fBackup3|xU/lAZ$Univers Medium(5hCEKQW]cioAutoList11.1.1.1.1.1.1.1.(TABLE BTABLE ATABLE CTABLE DTABLE E(0TABLE F@TABLE G}(TABLE HTABLE I !)USUS.,  _w"XXXX", E,X"X(.3$ !USUS.,  /lAZUnivers  1.3#37=CIQYag1.a.i.(1)(a)(i)1)a)$i)(;3$2#  0  .3  0  (EhCEKQW]cioAutoList21.1.1.1.1.1.1.1.'1.(UhCEKQW]cioAutoList31.1.1.1.1.1.1.1.*1.8}TABLE J d !USUS.,  _hh XXXX*,[-ddd Xdd Xdd X%%, dd ,*dd ,dd +  'hh '@ , E,X XStateofKansas d @DepartmentofSocialandRehabilitationServices H @nnChildrenandFamilyServices# XX, , E#Ԉ 9/!\  9 @9 9  &d%X XREPORTOF_UNEXCUSED_ԀSCHOOLABSENCES  d @ # XX% &d# X X(Definedin_KSA_Ԁ72977,721111,&721113)# XX #Ԉ 9/!F  96#6#GX% ^۽\X X @!!GX% CFS1006  d   " "AX%Rev.July2000  \ ""DX% Page1of2# XX\ ^۽#Ԉ1'%  1*[dd dd *dd *dd ,[-%%,dd ,dd ,dd ,dd ,add ,dd +     &d%X X % &dUSD#: '|  ' '|  'School: '|  ' '| 'Phone: '| '(|  (* [dddd dd dd dd add add [%%,bdd ,Jdd ,odd ,dd +  zz ContactPerson: .[F . 'F[ 'Title: 'F '(F  (0 t 0t%t%0$ %%0| $ %$ %(NotNecessarilyDesignatedReporter)D| %| % *[ddbdd bJdd Jodd odd  [%%,tdd ,dd ,dd ,dd ,dd ,'dd ,dd +     Semester: 'v  ' 'v  '1st 'v  ' 'v  '2nd 'v   'DatesAbsent: 'v  '(v   (*[ddtdd tdd dd dd dd 'dd 'dd [%%,dd ,dd ,0 dd ,dd +  t t  Grade: ' p  ' ' p  'NumberofPreviousReports: ' p  '( p   (A[) xdE #A  < ! *[dddd dd 0 dd 0 dd [%%,dd ,dd ,dd ,dd ,Xdd ,dd ,dd ,dd +    #   Student: ' } $ ' ' } % 'DOB: ' } & ' ' } ' 'Sex: ' } ( ' ' } ) 'Race: ' } *  '( } +  (3 |XS$ XtXX3 t   Last0 $ 0| $ %$ %0 | %| %First0, % %0,%,%0t%%M{ +t%t% *[dddd dd dd dd Xdd Xdd dd dd [%%,dd ,Idd ,Fdd ,dd +  I,I Parent(s): .[- . '.[ 'HomePhone: .[/ . '0[ 'HomeAddress: 'w1 ' 'w2 'WorkPhone: 'w3 '(w4   (A[) xdEB#A C5  Theitemscheckedbelowhavebeeninitialedbythisschoolinanefforttocorrectthisstudentsattendanceproblem:  7 (MarkN/Aifitemisinapplicable) 8 *[dddd Idd IFdd Fdd [ % %,dd ,dd ,dd +  T9T  +! : +Thestudenthasbeenmadeawareofhis/herattendancerecordandhasbeenencouragedtoattendschool  ; regularly. * < * +!P= +Thestudentsparent/guardianhasbeennotifiedthechildhasanattendanceproblem. * P> * 'J?  'Dates: .[J@ . 'JA[ ' +!B +Thestudenthasbeenreferredtohis/hercounselor򀀀timesthissemesterregardingregularschool C attendance. * zD * +!DE +Conference(s)has/havebeenheldwiththestudentsparent/guardianregardingthestudentsattendance DF record. * G * 't H  'Dates: .[t I . 't J[ ' +! nK +Thestudentsclassschedulehasbeenreviewed. *  nL * +!8" M +Astaffreviewhasbeenheldforthisstudent. * 8" N * '#2"O  'Dates: .[#2"P . '#2"Q[ ' +!$#R +Thestudentscasehasbeenreferredtotheschoolsocialworker. * $#S * +!^&$T +Thestudenthasbeenreferredtotheschoolpsychologist. * ^&$U * +!'X&V +Someonefromschoolhasvisitedthestudentshome. * 'X&W * +!")'X +Thestudentand/orhis/herfamilyhasbeenreferredtoacommunityagencyororganizationforassistantin ")'Y regularschoolattendance.+!)(Z  +*[d ddd dd dd [ % %,dd ,dd ,dd +  *)Z*)  'R+)[  'Additional R+)\ Notes: .[ ,*] . 2[!R+)^[ 2 5[$-,_[ 5 5[$.|-`[ 5+!F0.a  [ +# &d% # % &d D1/a   # &d% "$# p % &dCFS1006 h V$!!A%Rev.July,2000  ""E%Page2of2# &d%  p$# % &dԈ L A[) xdE Y#A Z  PLANNEDACTION: 󀀀UsethisspacetoinformlocalSRSstaffofanyactionstepsbeingtakenwiththestudent/family i tocorrecttheattendanceproblemwhichmayormaynotrequireSRSparticipation. 7 A[) xdE z#A {  BACKGROUNDINFORMATION: 󀀀Usethisspacetobrieflydescribeingeneraltermsanycircumstancesinthehome " whichrelatetostudentsattendanceproblems.(i.e.,unemployment,illness,divorce,deathinthefamily,etc.) X A[) xdE #A f"  SPECIFICCONCERNS: 󀀀Usethisspacetobrieflydescribespecificproblemsrelatedtothischild. u# A[) xdE &#A &%2 *[dddd dd dd [ % %,N dd ,dd ,dd ,dd +  'd&4'd& SignatureofDesignatedReporter: '0(&5 ' '0(&6 'Date: '0(&7 '(0(&8  ( A[) xdE *#A *b): # &d% H%# p % &dDISTRIBUTION:WhiteSRS;PinkParent/Custodian;YellowSchool +?*< ThisformsupercedesFormCY2871,_5/90# &d%  p,# % &d# &d% ,#_ M,*= 8qXXdd8____