6-8 LCWM Major Referral (2016-17)
Date of Incident
Time of Incident
(First & Last)
Abusive Language (Student uses abusive language towards / in front of other staff or students)
Defiance/Disrespect/ Non-Compliance (Student engages in refusal to follow directions, talks back and/or delivers socially rude interactions)
Disruption (Student engages in behavior causing an interruption in a class or activity. Disruption includes sustained loud talk, yelling, or screaming; noise with materials; horseplay or roughhousing; and/or sustained out-of-seat behavior)
Dress Code Violation (Student wears clothing that does not fit within the dress code guidelines practiced by the school/district)
Fighting/ Physical Aggression (Student engages in actions involving serious physical contact where injury may occur e.g., hitting, punching, hitting with an object, kicking, hair pulling, scratching.)
Forgery (Student has signed a person's name without that person's permission)
Harassment/ Bullying (Student delivers disrespectful messages (verbal or gestural) to another person that includes threats and intimidation, obscene gestures, pictures, or written notes)
Inappropriate Display of Affection (Student engages in inappropriate, consensual (as defined by school) verbal and/or physical gestures/contact, of a sexual nature to another student/adult.
Lying/Cheating (Student delivers message that is untrue and/or deliberately violates rules)
Property Damage/ Vandalism (Student participates in an activity that results in destruction or disfigurement of property)
Skip class (Student leaves or misses class without permission)
Technology Violation (Student engages in inappropriate (as defined by school) use of cell phone, music/video player, camera, and/or computer)
Theft (Student is in possession of, having passed on, or being responsible for removing someone else's property without that person's permission)
Tobacco Use/Possession (Student is in possession of or is using tobacco)
Use/ Possession of Alcohol (Student is in possession of or is using alcohol)
Use/ Possession of Drugs (Student is in possession of or is using illegal drugs/substances or imitations
3rd Minor Occured
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