STUDENT NAME: Click here to enter text.	STUDENT ID# Click here to enter text.

GRADE: Click here to enter text.	PERIOD: Click here to enter text.

DATE OF CORRECTION: Click here to enter text.

CHANGE TO:	Present ☐	Tardy ☐	Excused Tardy ☐	Tardy Truant ☐

(1-30 min.)	(31min or more)

School Business ☐	Location: Click here to enter text.	Event: Click here to enter text.

Click here to enter text.	Click here to enter text.	Click here to enter text.

Teacher Name	Teacher Signature	Date