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School Attendance Review Board (SARB) Referral
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SARB first step
Attachments
Referral Date
District
Arcata School District
Big Lagoon Union School District
Blue Lake Union Elementary School District
Bridgeville School District
Cuddeback Union School District
Cutten School District
Eureka City Schools
Ferndale Unified School District
Fieldbrook School District
Fortuna Elementary School District
Fortuna Union High School District
Freshwater School District
Garfield School District
Green Point School District
Humboldt County Office of Education
Hydesville School District
Jacoby Creek School District
Klamath-Trinity Joint Unified School District
Kneeland School District
Loleta Union School District
Maple Creek School District
Mattole Unified School District
McKinleyville Union School District
Northern Humboldt Union High School District
Orick School District
Pacific Union School District
Peninsula Union School District
Rio Dell School District
Scotia Union School District
South Bay Union School District
Southern Humboldt Unified School District
Trinidad Union School District
Unknown
School
Arcata Elementary School
Coastal Grove Charter
Fuente Nueva Charter
Redwood Coast Montessori
Sunny Brae Middle School
Union Street Charter
Big Lagoon School
Blue Lake Elementary School
Bridgeville School
Cuddeback Elementary School
Cutten School
Ridgewood School
Alice Birney School
Catherine L. Zane Middle School
Center For Independent Study
Eureka Adult School
Eureka High School
Grant School
Home and Hospital
Lafayette School
Lincoln Learning Center
Pacific View Charter School
Washington School
Winship Middle School
Zoe Barnum High School
Ferndale Elementary School
Ferndale High School
Fieldbrook School
Fortuna Middle School
Linell K. Walker Elementary School
Norman G. Ambrosini School
Redwood Preparatory Charter School
Toddy Thomas School
Academy of the Redwoods
East High School
Fortuna High School
Freshwater Charter Middle School
Freshwater School
Garfield School
Green Point School
Agnes J. Johnson Charter School
Eel River Community School
Eureka Community School
Garberville Community School
Glen Paul School
Northcoast Preparatory Academy
Northern United Humboldt Charter School
Hydesville School
Jacoby Creek School
Captain John Continuation
Hoopa Valley Elementary School
Hoopa Valley High School
Jack Norton Elementary School
Orleans Elementary School
Trinity Valley Elementary School
Weitchpec Elementary School
Kneeland Elementary
Loleta School
Maple Creek School
Honeydew School
Mattole School
Mattole Triple Junction High School
Dow’s Prairie School
McKinleyville Middle School
Morris School
Arcata High School
Laurel Tree Charter School
Mad River High School
McKinleyville High School
Pacific Coast High School
Six Rivers Charter High School
Orick School
Pacific Union School
Trillium Charter School
Peninsula School
Eagle Prairie Elementary School
Monument Middle School
Stanwood A. Murphy Elementary
Alder Grove Charter School
Pine Hill School
South Bay School
South Bay Charter Middle School
Casterlin School
Miranda Junior High
Osprey Learning Center
Redway School
South Fork High School
Whitethorn School
Trinidad School
Unknown
Student/Family Information
Student First Name
Student Last Name
Preferred Name
Date of Birth
SSID
SSID must be exactly 10 digits
Grade
K
1
2
3
4
5
6
7
8
9
10
11
12
Gender
Male
Female
Non-binary
Preferred Pronouns
He/Him
She/Her
They/Them
Ethnicity
Hispanic
Not Hispanic
Race 1
White
Black
American Indian or Alaskan Native
Pacific Islander
Middle Eastern
Japanese
Chinese
Korean
Cambodian
Vietnamese
Laotion
Hmong
Other Asian
Other
Race 2
White
Black
American Indian or Alaskan Native
Pacific Islander
Middle Eastern
Japanese
Chinese
Korean
Cambodian
Vietnamese
Laotion
Hmong
None
Other Asian
Other
Student Physical Address
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Mailing Address (if different)
City
State/Province
Zip/Postal
Parent/Guardian 1
First Name
Last Name
Phone
Same Address as Student?
Same Address as Student?
No
Same Address as Student?
Yes
Physical Address - Parent/Guardian 1
City
State/Province
Zip/Postal
Mailing Address (if different) - Parent/Guardian 1
City
State/Province
Zip/Postal
Parent/Guardian 2
First Name
Last Name
Phone
Same Address as Student?
Same Address as Student?
No
Same Address as Student?
Yes
Physical Address - Parent/Guardian 2
City
State/Province
Zip/Postal
Mailing Address (if different) - Parent/Guardian 2
City
State/Province
Zip/Postal
Primary Language
English
Spanish
French
Hmong
Tagalog
Other
Interpretation Needed
Interpretation Needed
No
Interpretation Needed
Yes
IEP
IEP
No
IEP
Yes
IEP Attendance Goal
IEP Attendance Goal
No
IEP Attendance Goal
Yes
Is the student/family involved in Child Welfare/Foster Youth Services?
Is the student/family involved in Child Welfare/Foster Youth Services?
No
Is the student/family involved in Child Welfare/Foster Youth Services?
Yes
Is the student/family involved in McKinney-Vento Homeless Youth Services?
Is the student/family involved in McKinney-Vento Homeless Youth Services?
No
Is the student/family involved in McKinney-Vento Homeless Youth Services?
Yes
Does the student have siblings in ANY school district
Does the student have siblings in ANY school district
No
Does the student have siblings in ANY school district
Yes
List Siblings
Sibling Name
Age
District
School
Add Another Sibling
Add Another Sibling
Add Another Sibling
Remove
Sibling Name
Age
District
School
adddropsib11
Add Another Sibling
adddropsib11
Remove
Sibling Name
Age
District
School
adddropsib21
Add Another Sibling
adddropsib21
Remove
Sibling Name
Age
District
School
adddropsib31
Add Another Sibling
adddropsib31
Remove
Sibling Name
Age
District
School
adddropsib41
Yes
adddropsib41
No
Sibling Name
Age
District
School
adddropsib51
Yes
adddropsib51
No
Sibling Name
Age
District
School
adddropsib61
Add Another Sibling
adddropsib61
Remove
Sibling Name
Age
District
School
adddropsib71
Add Another Sibling
adddropsib71
Remove
Sibling Name
Age
District
School
adddropsib81
Add Another Sibling
adddropsib81
Remove
Sibling Name
Age
District
School
Agencies/services with which the student/family is currently involved
Other Agencies/Services
Health Issues
Additional Supports in Place
Student Attendance Patterns
School Days Since Enrollment
Days of Excused Absences
Days of Unexcused Absences
Days Tardy >30 Minutes
Indicate number of DAYS, not number of periods
Days Suspended
Days Cut Classes
Is there a SARB from the Previous Year?
Yes
No
Unknown
Family Explanation of Barriers
Conferences Held or Attempted
Other Conferences held or Attempted
Date(s) Student Study Team Meeting Held or Attempted
Date(s) Student Attendance Review Team
Date(s) Parent Conference Held or Attempted
Date(s) of Home Visit(s)
Describe the Situation and Interventions/Supports Applied or Attempted
Summarize the Situation
Person Completing This Form
School Principal/Administrator Name