Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

2017-2018 Referral Form


  1. 1. Step One
  2. 2. Step Two
  3. 3. Step Three
  4. 4. Step Four
  • Step One

    1. Referral Source

    2. The information provided in this section of the truancy referral is to provide us with the contact information for the person that is submitting the truancy referral.

    3. Please enter your full name

    4. Examples: Principal, Assistant Principal, Dean, School Social Worker, Teacher, Attendance Clerk.

    5. (555) 555-5555 or 555-555-5555

    6. (555) 555-5555 or 555-555-5555

    7. Please enter your email address, so we may contact you.

    8. In this section, please let us know if there is someone that you would like us to contact directly for attendance update requests. This section is not required, but is helpful.

    9. (555) 555-5555

    10. Please use the list of Lake County districts and schools. The list for the schools is to be selected based on the school or Special Education/Alternative placement the student attends. For example, if the student is enrolled at Zion Benton High School, but physically attends Cyd Lash Academy, then you would select Cyd Lash Academy. If your school is not on here, please contact Andrea Kowitz at (847) 752-0169 or by email: Please keep in mind that if you are a private placement or therapeutic day school, the truancy referral must come from the home district. The only exceptions to this rule are SEDOL and NSSED, as they are considered to be public school districts providing Special Education services.