• School Discipline Form

• 
  
• Student Name (Last, First)*
• Student ID Number
• Grade
• Parent Name*
• Phone

  --
• Referring Teacher/Staff Member*
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• Describe the Issue

• Classroom/Behavior Issues*

  Disruptive Behavior Dress Code Inappropriate Behavior/Language Property Misuse/Vandalism Skipping Class Tardiness Technology Violation Theft Other
• If Other, please describe
• Safety Issues*

  Alcohol Bullying/Harrassment Drugs Fighting Theft Threat(s) Weapon Other
• If Other, please desribe
• Location Issue Occurred*

  Auditorium/Gym Bathroom Bus Cafeteria Classroom Library Parking Lot Playground
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• Action Taken

• Discipline*

  Classroom Adjustment (ex. seating change) Detention Expulsion Parent/Staff Meeting Police Intervention School Counseling Suspension Verbal Warning
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• Administration Notes*
• Administrator Signature
• Date