Truancy Intervention Panel Notes Form 2015-2016 Areas 1 & 2
E-mail of person completing form:
Date of TIP:
-
Month
-
Day
Year
Date Picker Icon
Student ID#:
Student's Full Name:
First Name
Last Name
Date of Birth (DOB):
-
Month
-
Day
Year
Date Picker Icon
Age:
*
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
Gender:
*
Male
Female
Race/Ethnicity:
*
Please Select
Black
White
Hispanic
Asian
Multi-Racial
School:
*
Please Select
Austell Elementary
Argyle Elementary
Belmont Hills Elementary
Birney Elementary
Bryant Elementary
Clarkdale Elementary
Clay Elementary
Compton Elementary
Fair Oaks Elementary
Green Acres Elementary
Harmony Leland Elementary
Hendricks Elementary
Hollydale Elementary
King Springs 2-5 Elementary
King Springs K-1 Elementary
Labelle Elementary
Mableton Elementary
Milford Elementary
Nickajack Elementary
Norton Park Elementary
Powder Springs Elementary
Riverside Intermediate
Riverside Primary
Russell Elementary
Sanders Elementay
Smyrna Elementary
Teasley Elementary
Campbell Middle
Cooper Middle
Floyd Middle
Garret Middle
Griffin Middle
Lindley 6th grade
Lindley Middle
Smitha Middle
Tapp Middle
Campbell High
Osborne High
Pebblebrook High
South Cobb High
Grade:
*
Please Select
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Total Number of Absences:
Total Number of Unexcused Absences:
Total Number of Excused Absences:
Total Number of Tardies:
When concerns occured:
Please Select
History
Recent
On-Going
Presenting Issues:
Medical
Academic
Mental Health
Financial
Emotional
Bullying/Teasing
Behavior
Family Vacation
Type of Contact:
Please Select
Face to Face
Telephone Conference
No-show
Reschedule
School Attendees:
*
School Social Worker (SSW)
Truancy Coordinator
Community Outreach Officer
Principal
Assistant Principal
Administrator
Professional Counselor
Community Member
Campus Officer
SSW Intern
Teacher
SSW (Supervisor)- Observation
School Nurse
Other
If "other" was checked in last question please explain:
Student/Family Present for TIP:
Mother
Father
Sister
Brother
Grandmother
Grandfather
Aunt
Uncle
Student
Cousin
Stepmother
Stepfather
Neighbor
Friend of Family
Comments/Notes:
Panel Recommendations:
Attendance Contract
Juvenile Court Complaint
Tutoring
Intensive Family Intervention (IFI)
Monitor Attendance
Case Management by SSW
Case Management by Truancy Coordinator
Group
Club/Sports
Nurse Plan
Make doctors appointment
Follow-up with Medicaid Application
Provide Medical Documenation
Other
If "other" was chosen for the above question please explain:
Attendance Policy & Law:
The GA Compulsory Attendance Law & Cobb County County School District Attendance Policy was explained to Parent
The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to Student
The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to Parent & Student
The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to and signed by parent
The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained to and signed by student
The GA Compulsory Attendance Law & Cobb County School District Attendance Policy was explained and signed by student and parent
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