ELEMENTARY SCHOOL
COUNT DAY ABSENCE FORM
Form C
SCHOOL YEAR SCHOOL DISTRICT
COUNT DAY SCHOOL BLDG/PROG
SCHOOL CODE BUILDING CODE
INSTRUCTIONS:
List each pupil absent on the count day. Note the grade of the pupil, the type of absence,
and the date the pupil returned to school. Determine the FTE based upon whether the
the pupil returned within the appropriate time frame. (Pupil Accounting Manual 3-3)
Please note that you need to record absences for both a.m. and p.m. and return dates for both.
G TYPE
R A.M. P.M. OF FTE
NAME A ABSENCE DATE MEMBERSHIP
(LAST, FIRST) D (Excused or RETURNED REPORTED
E Unexcused) A.M. P.M.
1. Doe, Jane 3rd X X Excused 10-Oct 10-Oct 1.00
2.
3.
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5.
6.
7.
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11.
12.
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14.
15.
16.
17.
18.
19.
20.
I certify that this is a true and accurate list of all eligible FTE reported for pupils who were absent on the
count day.
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Authorized Representative Date
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Title of Authorized Representative