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(UTC-02:00) Coordinated Universal Time-02
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(UTC) Coordinated Universal Time
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(UTC+10:00) Vladivostok
(UTC+11:00) Magadan, Solomon Is., New Caledonia
(UTC+12:00) Auckland, Wellington
(UTC+12:00) Coordinated Universal Time+12
(UTC+12:00) Fiji Is., Marshall Is.
(UTC+12:00) Petropavlovsk-Kamchatsky
(UTC+13:00) Nuku'alofa
(UTC+13:00) Midway Island, Samoa
Request for AIM Letter
Date
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For Which Language?
Interpreter needed?
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Name
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Student's Email
Lives With? (select all that apply)
Mother
Father
Legal Guardian
Enter complete parent/guardian information. If
address is the
same as other parent
, please put Same as ...
Information for:
Mother
Father
Legal Guardian
Name
Home Phone
Cell Phone
Email
Address
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HI
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ID
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IN
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KY
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MA
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OR
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Information for:
Mother
Father
Legal 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?
Yes
No
Please specify the county the student is transferring from:
Type of Attendance:
Distance Learning
Hybrid
In-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
Yes
No
Is the student currently failing any classes?
Yes
No
Which classes?
Is the student at risk of failing any current classes?
Yes
No
Which classes?
The school must be contacted for approval if parent/guardian requests to reschedule?
Yes
No
Please upload the student's current attendance records along with this referal
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