"CCPS RESTORATIVE CONFERENCE PROGRAM REFERRAL FORM: AN ALTERNTIVE TO SUSPENSION FOR MIDDLE AND HIGH SCHOOLS
Disposition Code: 6118

CCPS Restortive Conference Program is a Weekly One-Hour alternative to supsension virtual Program for middle and high schools, and it is grounded on the Restorative Proactices. The CCPS Restorative Conference is designed to accomplish the following:
1. Create opportunity to address needs of all parties involved.
2. Help students learn from mistake(s) and take responsibility for their actions.
3. Resolve Conflict.
4. Repair Harm if any.
5. Build or Restore/strengthen Relationship.
6. Prevent the inappropriate behavior from occuring again ( Prevent re-victimization).
7. Create a Pathway to reintegrate the person that harmed or caused impact.

Restorative Conference is NOT a platform to assign blame, or determine innocence or guilt, or handle contentious cases. Restorative Conference will not be the appropriate response where the student who caused harm/facing suspension is not willing and ready to take responsibility or ownership of his/her behavior or action.

The Program Sessions are held on Wednesdays and Thursdays, between 6:00 pm and 8:00 pm. There are two separate one hour sessions for middle and high schools on both days. The Restorative Conference Facilitator will provide the link or location for the conference upon receipt of the Referral. Each session lasts for one hour 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 incident may be between students or between a student and school personnel. The parents of student(s) who caused harm (that is student facing suspension) or who was harmed, are expected to participate. In all cases, the person harmed and the person who caused harm must voluntarily agree to participate and adhere to all resolutions reached during the Restorative Conference for the Conference to occur. The student facing suspension (who caused harm) will have up to two weeks to complete all agreed tasks in lieu of suspension.

The Restorative Conference Facilitator, will follow up with all parties after 30 days from the date of the Restorative Conference to verify whether the conflict has been resolved, all agreeements adhered to, and if there is further action needed to sustain positive relationship.

In the event of an emergency resulting in the student (facing suspension) and parent being unable to participate in the Restorative Conference as scheduled, the principal of the student’s school should be notified immediately.
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Email *
Please select date for Restorative Conference (must be either Wednesday or Thursday) *
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Please select Time for Restorative Conference. *
SCHOOL *
STUDENT'S FIRST AND LAST NAME (Student facing Suspension) *
STUDENT GRADE ((Student facing Suspension) *
STUDENT DATE OF BIRTH (Student facing Suspension) *
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STUDENT ADDRESS (Student facing Suspension) *
PARENTS/GUARDIANS' FIRST AND LAST NAME( Parent of Student facing suspension) *
PARENT/GUARDIAN EMAIL ADDRESS (REQUIRED) *
PARENT/GUARDIAN PHONE #:
STUDENT CODE OF CONDUCT ITEM *
STUDENT AGREEMENT: I have accepted the option given to me by the Clayton County Board of Education to attend the “RESTORATIVE CONFERENCE” program indicated above. In accepting this opportunity, I agree to abide by the guidelines, agreements, resolutions and other conditions set forth in this program. I understand that up to six (6) days of suspension may be taken from my total suspension period for the above offense. I understand that if I do not participate in the Conference and complete all Conference Resolutions within two weeks from the date of the Conference, I will be terminated from the program and the assigned suspension will be enforced. I agree to attend, complete the session and all conference resolutions/tasks. I also agree to join the Conference (virtually or in-person) at least ten minutes before the scheduled time and remain for the entire one-hour session. *
PARENT AGREEMENT - As parent or guardian of the above named student who is facing suspension, I agree to participate and ensure that my son/daughter joins the session, participates in the assigned “RESTORATIVE CONFERENCE” program session, and completes all conference resolutions/tasks within 2 weeks from the date of the Conference in order to give my son/daughter the opportunity to continue his/ her educational program in the virtual or face to face classroom. *
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 harmed/impacted, I agree to participate and ensure that my son/daughter participates in the assigned “RESTORATIVE CONFERENCE” program session, and completes all conference resolutions/activities (if any) within 2 weeks from the date of the Conference. *
30th Day (from date of initial Conference) Follow up by the Restorative Conference Facilitator *
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FIRST AND LAST NAME OF ADMINISTRATOR 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 the Program Contact/Facilitator and Parent to confirm Registration for the Program sessions. *
A copy of your responses will be emailed to the address you provided.
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