2012-2013 School Absenteeism Survey

*Only illness absentees are to be reported, not absentees due to sports trips, school activity trips, dental appointment, vacations, etc. A student is counted for each day absent. If a student is absent 3 days in a week he/she would be counted 3 times.

If you have questions please do not hesitate to contact Vickie Horan, 773-3737 or 800-592-1861.

* 5. School point of contact: (Name)

* 6. Phone number for Point of Contact:

* 7. Number of students enrolled: (please enter a number)

* 8. Number of student absent days due to illness: (please enter a number)

* 9. Number of staff: (If no data enter 0)

* 10. Number of staff absent days due to illness: (If no data enter 0)

* 11. Number of scheduled school days this week:

* 12. Was school closed any days this week?

* 13. If yes, why was the school closed? (i.e. snow day, in-service, vacation, illness, etc):

* 14. If yes, how many days was your school closed? (Please enter a number)