MONTGOMERY COUNTY PUBLIC SCHOOLS
Attendance Intervention Plan – Individual Teacher
Wootton High School
Student’s Name: _____________________________________
Course Name: ____________________________________
ID #: ____________________
Grade: _____________
Teacher Name: _____________________________________
Reason for Plan
We are developing this intervention plan because the student listed above has five (5) or more absences in the course listed above.
Attendance Intervention
A commitment to school attendance is an essential component of a quality learning experience and regular attendance and engagement
are required in order to demonstrate mastery of the material. The student will work with the teacher to identify areas to improve
attendance. Please check all that apply:
□ The student will arrive to class on time every day.
□ The student will attend class every day.
□ If the student is absent, the absence will be lawful (excused) and a note will be turned in the attendance office within three (3) days
of returning from the absence.
□ OTHER: ____________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Academic Work
Original Due
Date
Assignment Title
Deadline
Completed
Not Completed
Student Understanding
I understand that I must follow the items checked in the Attendance Intervention section above to receive a grade in this course. If I do
not follow the items checked, I understand that I will be in danger of failing the course.
Student’s Signature: ___________________________________________________
Date: _____________________________
Parent/Guardian Contact
I contacted the parent/guardian (check one): □ BY PHONE
(talked, not msg.)
□ BY EMAIL
□ IN PERSON on _______________________
(attach parent response)
(date of contact)
Teacher’s Initials: __________
Plan Acceptance
Teacher’s Signature: ___________________________________________________
Date: _____________________________
Counselor’s Signature: _________________________________________________
Date: _____________________________
Administrator’s Signature: ______________________________________________
Date: _____________________________
Plan successfully completed (check one):
□ YES
□ NO
Teacher’s Signature: _____________________________________
Administrator’s Signature: _____________________________________________
Date: ______________________________