Submit a Truancy Referral (School Staff & Community Agencies) Please enable JavaScript in your browser to complete this form. - Step 1 of 2Information About YouReferral Submitted By: *FirstLastTitle *School or Community Agency *Where you work. If you do not work for a school or community agency please enter where you work or who you represent. Email *Phone *NextYouth's InformationYouth's Name *FirstLastSchool NameWhere youth is currently enrolled. If currently unenrolled, please enter the school the youth is zoned for based on youth's home address. Student Number *If unknown, please type in 0Youth's Grade *Number of School Days Missed This Year *Date of Birth *Gender * FemaleGender NeutralMaleUnknownRace WhiteBlack or African AmericanAmerican Indian and Alaska NativeAsianNative Hawaiian and Other Pacific IslanderTwo or More RacesOther RaceHispanic Origin YesNoParent's Information Parent/Guardian's Name *Interpreter Requested for ParentLanguageAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code *Parent/Guardian's Phone *NotesCCSD Release of Information (Optional) Click or drag files to this area to upload. You can upload up to 3 files. CCSD Staff: Please submit a completed release of information if you request to receive information regarding the appointment.PreviousWebsiteSubmit