HOUSTON ISD
2020-2021

PERIOD ATTENDANCE CHANGE FORM

DATE:  	

STUDENT NAME: 		Student ID#:  	

GRADE LEVEL: 		ADVISOR NAME:  	

DATE(S) OF ATTENDANCE CHANGE:  	

ADA Period:  	

INDICATE NON-ADA PERIOD:  	

FROM: (CIRCLE ONE)	PRESENT		ABSENT		
TO: (CIRCLE ONE)	PRESENT		ABSENT		
REASON: (CIRCLE ONE)	ER	RH		OSP	

MD

ER:	Error
RH:	Religious Holiday
OSP: Other School Personnel MD:	Medical Excuse

SCHOOL PERSONNEL SIGNATURE	PRINCIPAL APPROVED SUPPORTING DOCUMENTATION MUST BE ATTACHED