Fill and Sign the Request for Custody by Form

JD-1703, 04/08 Request for Custody by School Attendance Officer/ Designation by School District Administrator §§118.16(2m)(a), 938.19(1m), 938.20, Wis. S tats. This form shall not be modified. It may be suppleme nted with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Request for Custody by School Attendance Officer/ Designation by School District Administrator D ate of Birth Case No. For Official Use 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 ac ceptable excuse. The previous attendance record of the juvenile is as follows: See attached 3. I request that the juvenile be taken into custod y by a person designated by the school district adm inistrator. 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 inv olved in the provision of educational programs for the truant child: 2. An employee of the district who is directly inv olved in the provision of a modified program or cur riculum, a program for children at risk, an alternative educational program, or any other alternative educational 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 t elephone the juvenile's parent, guardian, legal cus todian and Indian custodian that I have designated individual(s) for the purpos e of taking the juvenile into custody. Such attemp t was successfully made: by phone in person on (date) at (time) . unnecessary because the parent, guardian, legal cu stodian, or Indian custodian is the person who requested that the juvenile be taken into custody. Upon taking the juvenile into custody, the person s hall: • determine if the juvenile may be released under §938.20, Wis. Stats.; and • if release is not appropriate, deliver the juven ile to juvenile intake. Signature of School District Administrator Distribution: 1. Original – School District Administrator 2. Person taking juvenile into custody 3. Parent/guardian/legal custodian/Indian custodian Date