JD-1703, 04/08 Request for Custody by School Attendance Officer/Designation by School District Administrator 247247118.16(2m)(a), 938.19(1m), and 938.20, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Request for Custody by School Attendance Officer/Designation by School District Administrato r Case No. Request for Custody by School Attendance Officer 1. I am the school attendance officer for the School District. 2. The juvenile is absent from school without an acceptable excuse. The previous attendance record of the juvenile is as follows: See a ttached 3. I request that the juvenile be taken into custody by a person designated by the school district administrator. Signature of School District Administrator Date Designation by School District Administrator Based on the request of the school attendance officer, I direct the following person(s) take the juvenile into custody: Those persons previously designated by me pursuant to a blanket authorization issued on [Date ] . The following individual(s): 1. An employee of the district who is directly involved in the provision of educational programs for the truant child: 2. An employee of the district who is directly involved in the provision of a modified program or curriculum, a program for children at risk, an alternative educational program, or any other alternative educati onal program to children who attend the school attended by the truant child: 3. A school social worker employed by the district who provides services to children attending the school attended by the truant child: 4. An employee of a social services agency who is directly involved in the provision of social services to the truant child or the child's family: 5. The school attendance officer: I have attempted to notify by personal contact or telephone the juvenile's parent, guardian , legal custodian and Indian custodian that I have designated individual(s) for the purpose of taking the juvenile into custody. Such attempt was successfully made: by phone in person on [Date] at [Time] . unnecessar y because the parent, guardian, legal custodian , or Indian custodian is the person who requested that the juvenile be taken into custody. Upon taking the juvenile into custody, the person shall: determine if the juvenile may be released under 247938.20, Wis. Stats.; and if release is not appropriate, deliver the juve nile to juvenile intake. DISTRIBUTION: 1. School District Administrator 2. Person taking juvenile into custody 3. Parent/guardian/legal custodian/Indian custodian Signature of School District Administrator Date American LegalNet, Inc. www.FormsWorkFlow.com