Request for AIM Letter Date You are unable to save progress to this form. Please have all relevant information available to fill out this form in it's entirety prior to starting. For Which Language? Interpreter needed? YesNo Name Age Grade Date of Birth Gender Address MaleFemale Other     City State ZIP Code AL AA AE AK AP AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Student's Email Lives With? (select all that apply) MotherFatherLegal Guardian Enter complete parent/guardian information. If address is the same as other parent, please put Same as ... Information for: MotherFatherLegal Guardian Name Home Phone Cell Phone Email Address City State ZIP Code AL AA AE AK AP AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Information for: MotherFatherLegal Guardian Name Home Phone Cell Phone Email Address City State ZIP Code AL AA AE AK AP AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Add another parent/guardian School has sent a letter to the parents when the student has had 3 unexcused absences. Date Letter Sent If applicable, what technological means does the student have to be able to engage in distance learning as expected? How does the school track attendance for distance learning, ie what is the student expected to do to be marked attendance compliant? What is your school’s policy or protocol for engaging students/families who are not participating in distance learning as expected? What has the school done to engage this student according to this policy? Communication with Parents Other Distance learning engagement Doctor's Note Meeting with Student School Consequences Other Official and Title Phone Name of School District Email (to receive a confirmation email) Previous school attended Is this student a transfer from another county? YesNo Please specify the county the student is transferring from: Type of Attendance: Distance LearningHybridIn-Person Please indicate which days of the week are distance learning and which are in person at school: ​Consult required? - Unexcused absences are largely/solely occurring while the student is physically in the building​ YesNo Is the student currently failing any classes? YesNo Which classes? Is the student at risk of failing any current classes? YesNo Which classes? The school must be contacted for approval if parent/guardian requests to reschedule​? YesNo Please upload the student's current attendance records along with this referal * Add Attachment Select a file Name The maximum file size allowed is: 100 MB If you wish to retain a copy of your referral, please print a copy BEFORE submitting! Workflow Status PendingN/ANotify TruancyTruancy Notified