Home Study Program Monthly Attendance Sheet

Department of Education
HOME STUDY PROGRAM MONTHLY ATTENDANCE RECORD
Submitted by: Submitted to:
Name ___________________________________________ ____________________________________School System (in which program is located)
________________________________________
Address of ______________________________________
Home Study
Program _______________________________________ ________________________________________
_______________________________________ _________________________________________
School Year: Beginning date ____/____/____: Ending date ____/____/____ School Month: ___1, ___2, ___3, ___4, ___5, ___6, ___7, ___8, ___9, ___10, ___11, ___12
Days in Month
Name of Student
1 2 3 4 5 6 7 8 9 1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0
3
1
Total Days
Attended This
Month
Total Days Year to
Date
Submitted by: __________________________________________________ Name of Tutor (if applicable) _______________________________________________
Signature of Parent or Guardian
Instructions:
Date: ___________________________________
1.
2.
3.
4.
5.
Fill in your name and the address of the Home Study Program as it appears on your Declaration of Intent to Utilized a Home Study Program.
Fill in the beginning and ending dates for the school year as they appear on your Declaration of Intent to Utilize a Home Study Program.
Indicate for which monthly period you are reporting by marking the appropriate number beside School Month.
List each student’s name as it appears on your Declaration of Intent to Utilize a Home Study Program.
For each day during the monthly period that a student DID have classes, mark an “X” in the box. Click here to reset form
6. Sign your name and fill in the date as of the day you mail or deliver this report to the local school system.
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