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BHSC Discipline Referral
* Indicates required question
Email
*
Record my email address with my response
Student Name
*
Your answer
Grade
Choose
9th
10th
11th
12th
Reason for referral, be specific.
Your answer
Every time you complete a discipline referral for a student, you must contact a parent. Have parents been contacted about this issue?
*
Yes
Not yet, but I will contact parents
Required
Teacher/staff Submitting Referral
*
Your answer
A copy of your responses will be emailed to .
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