NOTIFICATION TO DISTRICT ATTORNEY OFFENSE: (GS 115c-378) Misdemeanor violation of the North Carolina Compulsory School Attendance Law RESPONSIBLE PARTY: _______________________________________________________ RELATIONSHIP TO STUDENT: ________________________________ ADDRESS: __________________________________________________________________ CITY: _______________________ STATE: _______________________ ZIP: ____________ RACE: ______________________ SEX: __________________________ D.O.B.: _________ TELEPHONE: ________________________________________________________________ STUDENT’S NAME: __________________________________________________________ SCHOOL: ____________________________________________ STUDENT’S D.O.B.: _____________________ AGE: ________________ GRADE: ________ COMPLAINANT: After conferring with the student and the person legally responsible for the student as named above it has been determined that the person legally responsible for the student has not made good faith effort to comply with the provisions of N.C. General Statue 115C et. Seq. SCHOOL PRINCIPAL’S SIGNATURE ______________________________________________ DATE: ____________________ TOTAL NUMBER OF ABSENCES ____________ (Attendance Summary Included) UNEXCUSED ABSENCES: __________________ EXCUSED ABSENCES: _____________________ File original with magistrate and send copy to Truancy Court Liaison Alan D. Rutherford Educational Center * 410 Garfield Street * Statesville, NC 28677 * Phone: 704-832-2506 * Fax: 704-978-0078