1920 Behavior Referral
Use this form to complete both a teacher referral or principal referral. Once you select Teacher, for the type of referral, we will collect the data and there will not be follow up by either Kara or Bob. If you select Principal, we will review existing data for the student and make a decision for a consequence for the infraction. In both instances, you will receive an email with a referral that can be printed or emailed to the parent. If it is a Principal referral, you will receive a second email which includes the principal's decision and consequence.
Email address *
Staff Reporting Incident *
ex. Mr. Washington, Miss Jefferson (Please do not use first name it automatically loads into the referral)
Your answer
Type of Referral *
Date *
Time *
Student First Name *
Your answer
Student Last Name *
Your answer
Grade *
Gender *
Ethnicity *
Based upon VDOE Ethnicity Codes
Location of Incident *
Others Involved *
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