Kent ISD
Truancy and Expulsion Form Submission


Attendance Affidavit and Referral FormTM

School Information

** Date Parent / Guardian was notified by a local school administrator by letter or telephone call.
   Michigan Law requires this notification before referral to the Kent ISD Office of Truancy and School Attendance.

Student Information
Male Female
Yes  No
*** Please attach the IEP to this referral ***
Yes  No
Please explain "Other" in comments section
Yes  No

Yes  No
Yes  No
Yes  No
Yes  No
Parent / Legal Guardian 1
Mr.  Mrs.  Ms. 
Yes  No 1

1If no, it is the school's responsibility to translate to the family.
Parent / Legal Guardian 2
Yes  No
Mr.  Mrs.  Ms. 
Yes  No
Yes  No 2

2If no, it is the school's responsibility to translate to the family.
Referral Information
1st  2nd  3rd  4th  5th  6th  7th  8th  9th 
Days Possible
i.e. Exceptional medical (such as hospitalizations, funerals & court) -- DO NOT include COUNTED ABSENCES
as of
You must choose the method used to calculate how time was lost.
Lost Learning Time (LLT) due to COUNTED absences only. Does not include tardies, early departures, etc.
Total Lost Learning Time (TLLT) including COUNTED class period absences, tardy class periods, late arrivals and early departures
Attendance is collected twice a day
Attendance is collected each class period (6 hour day)

Full-day absent F

Each half-day absent A 91 minutes or more

Each day tardy T Tardy, 35 minutes or less

Each day late L Late arrival, 36-90 minutes

Early departure D Early departure, 35 minutes or less

Extra early departure Z Extra early departure, 36-90 minutes

Full-day absent F

Each Class period Absent (not including full days) A

Each Class Period Tardy T

Each Day Early Departure D
(The number of times tardy to 1st hour only)

By checking this box, under penalties of perjury, I declare that I have examined this affidavit and any accompanying statements or attachments, and to the best of my knowledge and belief, they are true, correct and complete.