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Student Discipline Form
For Documentation Only
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Student Name
Your answer
Grade
Your answer
Person issuing the discipline
Your answer
Date:
Your answer
Action
For Documentation Only
30 Minute Detention- Not a Step
Step Detention
In School Suspension
Out of School Suspension
Talked to Student
Called Parents
Notified Authorities (Police Officer)
Sent to the Office
Other:
Reason for Referral
Annoying to Classmates
Mischief
Not prepared for class
Rude, Discourteous
Destruction of School Property
Homework/Assignments not Done
Inappropriate Behavior
Fighting/Bullying/Threatening
Not paying attention
Inappropriate Language
Lack of Cooperation
Talking
Gum/Food/Candy
Other:
Explanation of Incident
Your answer
Number of Days for Suspension/Detention
Your answer
Principal's Comments
Your answer
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