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OCDSB 967 Referral to Attendance CounsellorReferral to Attendance Counsellor Please complete this form for compulsory aged students only 6-17yrs with prolonged absence. Prolonged Absence is defined as the absence of a pupil for 15 consecutive school days without appropriate supporting documentation. For prolonged absences a referral MUST be made to the attendance counsellor (OCDSB school social worker) between the 11th and 16th consecutive day of absence for the student to remain on the roll. OEN: ___________________ Grade: __________________ Student Name: _____________________________ School: ___________________________________ Date of Referral (Day 11-16): Referring Principal/Designate: _____________________ Attached: Daily Attendance Record Short Index Card Copy of First Attendance Letter to Parent(s)/Guardian(s) (if sent) For School Use: Referral made (C code entered) Referral accepted in writing 16-30 days: 2-way contact confirmed (C code entered) Date of contact: _____________ Type of contact: 31-45 days: 2-way contact confirmed (C code entered) Date of contact: _____________ Type of contact: _____________________ 46-60 days: 2-way contact confirmed (C code entered) Date of contact: _____________ Type of contact: ______________________ Reason for Closing Referral (check one if applicable): Student returned to school Date: ___________________________ Student removed from register Date: ___________________________ Supporting medical documentation received Date: ___________________________ Signature of Principal: ______________________________ OCDSB 967 (September 2019) Original to be filed in OSR Copy to Social Worker First day of absence: *For 6-13 year olds, written evidence must be provided every 15 days for the file to remain active.