2019-2020 Detention & Office Referral Form
Please use this form to document if classroom managed discipline was utilized, or if the behavior requires administrator action in the form of a office referral.

If submitting a detention, please complete the green detention form on paper, provide a paper copy to the student, contact parents/guardians, then complete and submit the following form below online.

Please e-mail or see Scott Stasa if you have any questions scott.stasa@weschools.org.
1. Staff Member's Name (Last Name, First Name) *
Your answer
2. Student's Name (Last Name, First Name) *
Your answer
3. Is the student's behavior considered classroom managed or office managed? *
4. If classroom managed, select date of detention assigned (Tues/Thurs 3:15-4:00 Room 109).
MM
/
DD
/
YYYY
5. Student's Grade Level *
6. Does the student receive special education services? *
7. Student's Ethnicity. *
8. Date of Incident Occurrence *
MM
/
DD
/
YYYY
9. Approximate Time of Incident Occurrence *
10. Location of Incident Occurrence. *
11. Written Description of Incident *
Your answer
12. Student Behavior Category. Please select all that apply. *
Required
13. Interventions Used Prior to Submitting Form. Select all that apply. *
Required
Communication
Communication must be made to the student's parents/guardians by the staff member issuing the detention. Please stop in to the main office if you need assistance locating a student's contact information.
14. Communication to parent/guardian: *
Required
Submit
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