CCPS SCHOOL BASED REINTEGRATION CONFERENCE - REFERRAL FORM (All Schools)
CCPS Reintegration Conference Program is school based and is grounded on Restorative Practices. The Restorative Conference Approach undergirds the Reintegration Conference. The CCPS Reintegration Conference Program is designed to accomplish the following:

1. Create a Pathway to reintegrate into the class or school community the scholar who is returning from suspension or who just completed one of the Alternatives to Suspension Programs with the exception of the Restorative Conference Program.
2. Create opportunity to address the needs of all parties involved.
3. Promote individual accountability by helping scholars learn from mistake(s), make good choices, and do the right thing even when no one is watching.
4. Resolve Conflict if any.
5. Repair Harm, Build or Restore Relationship where applicable.
6. Prevent or reduce the likelihood that the inappropriate behavior will happen again.

Reintegration Conference is NOT a platform to assign blame, shame, or determine innocence or guilt, or handle contentious cases.

The Reintegration Conferences are held as needed and are facilitated by the school assigned Behavior Intervention Specialist (BIS). The Conference will be held on a day (Monday to Friday), time, and location convenient to all parties ( in-person or virtual). The Reintegration Conference Facilitator (BIS) will confirm the date, location and time for the conference upon receipt of the Referral. Each session lasts for approximately one hour or less, and is incident-specific. This means that only the persons who are involved or impacted by that specific incident or behavior are expected to participate and this could be students, teachers/school personnel and/or administrators. The student who returned from suspension is required to participate with parental consent if student is under 18 years. The incident may be between students or between a student and school personnel.

The parent(s) of student who caused harm (that is student who returned from suspension or who completed one of the Alternatives to Suspension Programs - ATS) and the parent(s) of the student who was harmed/impacted are not required to participate in the Conference. The Conference will proceed with or without the participation of the student or staff impacted by the incident. All parties who participate in the Conference will be expected to adhere to all the activities/agreement reached duirng the Conference.

The Reintegration Conference Facilitator (BIS) will follow up with all parties after 30 days from the date of the Reintegration Conference to ensure that all needs are addressed and that the student who returned from suspension/completed the ATS Program has been fully reintegrated into the classroom or school community.

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Email *
Please select preferred date for Reintegration Conference (Monday through Thursday). You may select 2 different days. *
Please indicate preferred time for the Reintegration Conference (May indicate 3 different times) *
SCHOOL *
STUDENT'S FIRST AND LAST NAME (Student who returned from Suspension) *
STUDENT GRADE (Student who returned from suspension) *
DATE OFBIRTH OF STUDENT (Student who returned from suspension) *
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PARENTS/GUARDIANS' FIRST AND LAST NAME( Parent of Student who returned from suspension) *
PARENT/GUARDIAN EMAIL ADDRESS (REQUIRED) *
PARENT/GUARDIAN PHONE #:
STUDENT CODE OF CONDUCT ITEM *
PARENT AGREEMENT - As parent or guardian of the above named student who returned from suspension, I give consent for my son/daugher to participate in the Reintegration Conference and will ensure that my son/daughter completes all conference agreements/activities. My participation is not required but I have the option to participate in the Conference as needed. *
First and Last Name of Student or Staff Harmed/Impacted. *
Grade of Student or Title of Staff Harmed/Impacted. *
Date of Birth of Student harmed/Impacted. *
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Name of Parent/Guardian of Student Harmed/Impacted. *
Email address of Parent of Student Harmed/Impacted.
PARENT AGREEMENT - As parent or guardian of the student impacted/harmed, I give consent for my son/daugher to participate in the Reintegration Conference and will ensure that my son/daughter completes all conference agreements/activities. I am not required to participate in the Conference but I have the option to participate as needed. I understand that the Conference will proceed with or without my son/daughter or myself. *
30th Day (from the date of initial Reintegration Conference) Follow up by the Reintegration Conferene Facilitator (BIS). *
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FIRST AND LAST NAME OF ADMINISTRATOR/CIRCLE OF SUPPORT MEMBER INITIATING REFERRAL *
Next Step: After you Submit the Referral Form, you will automatically receive a copy of the referral you submitted in your Email. You must FORWARD a copy of this electronic Referral to your assigned Behavior Intervention Specialist and Parents to confirm Registration for the Program sessions. *
A copy of your responses will be emailed to the address you provided.
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