Attendance USA · Module 2 Resource
Questionnaire to Determine Root Causes
Please share the following reasons as to why you are absent from school. Check Yes or No for each statement.
| Statement | Yes | No |
|---|---|---|
| I have reliable transportation to and from school. | ||
| I travel out of town and/or the country. | ||
| I am sick often. | ||
| I stay home with my sick parent(s) and/or family member(s). | ||
| I work a job outside of school. | ||
| I stay home to take care of my child and/or younger siblings. | ||
| I am tired and lack sleep. | ||
| I feel unsafe at school, on the bus, while walking to school, etc. | ||
| The students at school are unkind to me. | ||
| I feel sad often. | ||
| The weather is too bad to attend school. | ||
| I am behind in my school assignments and homework. | ||
| I don’t think it would matter if I was absent from school/class. | ||
| Test/exam days make me really nervous. | ||
| My parent/guardian encourages me to come to school on a regular basis. | ||
| I look forward to coming to school each day. | ||
| My classes are interesting. | ||
| I participate in school-sponsored sports, activities and clubs. | ||
| I have a good relationship with my teachers and other adults in the school. | ||
| I have the school supplies and technology needed to be successful at school. | ||
| I participate in sports and other activities outside of school. | ||
| I have friends at school. | ||
| I have clean school clothes and shoes to attend school. | ||
| I have temporary housing. |