Wray School District RD-2 Referral Form Definitions PBIS.xlsx
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WRAY SCHOOL DISTRICT RD-2 REFERRAL FORM DEFINITIONS 3.5.18
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OFFICE REFERRAL DEFINITIONS
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MINOR PROBLEM BEHAVIORCodeDefinitionPossible ConsequencesPolicy
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Defiance/Insubordination/Non-ComplianceM-DefianceStudent engages in brief or low-intensity failure to follow directions or talks back.JICDA (26)
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DisrespectM-DisrespectStudent delivers low-intensity, socially rude or dismissive messages to adults or students.CONFERENCE WITH STUDENTJICDA (6)
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DisruptionM-DisruptionStudent engages in low-intensity, but inappropriate disruption. JICDA (25)
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Dress Code ViolationM-DressStudent wears clothing that is near, but not within, the dress code guidelines defined by the school/district.INDIVIDUAL INSTRUCTIONJICA (10)
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Inappropriate LanguageM-Inapp LanStudent engaes in low-intensity instance of inappropriate language. JICDA (6 & 20)
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Physical Contact/Physical AggressionM-ContactStudent engages in non-serious, but inappropriate physical contact.LOSS OF PRIVILEDGESJICDA (4) HCDD
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Property MisuseM-Prpty MisuseStudent engages in low-intensity misuse of property JICDA (1 &2)
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TardyM-TardyStudent arrives at class after the bell (or signal that class has started).PARENT CONTACTJICDA (10 & 25)
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OtherM-OtherStudent angages in any other minor problem behaviors that do not fall within the above catagories. JICDA
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MAJOR PROBLEM BEHAVIORCodeDefinitionPossible ConsequencesPolicy
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Abusive Language/Inappropriate Language/ProfanityInapp LanStudent delivers verbal messages that include swearing, name calling, or use of words in an inappropriate wayLoss /ISS/OSSJICDA (6 & 20)
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ArsonArsonStudent planned and/or participates in malicious burning of property.OSS/ExpulsionJICDA (9)
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Bomb Threat/False AlarmBombStudent delivers a message of possible explosive material's being on-campus, near campus, and or pending explosion.OSS/ExpulsionJICDA (9)
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BullyingBullyingThe delivery of direct or technology-based messages that involve intimidation, teasing, taunting, threats or name calling.Loss /ISS/OSSJICDA (8)
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Defiance/Insubordination/Non-ComplianceDefianceStudent engages in refusal to follow directions or talks back.Loss /ISS/OSSJICDA (26)
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DisrespectDisrespectStudent delivers sociallly rude or dismissive messages to adults or students.Loss /ISS/OSSJICDA (6)
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DisruptionDisruptionStudent engages in behavior causing an interruption in a class or activity. Disruption includes sustained loud talk, yelling, or screaming;noise with materials, horseplay or roughhousing; and/or sustained out-of-seat behaviorLoss /ISS/OSSJICDA (25)
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Dress Code ViolationDressStudent wears clothing that does not fit within the dress code guidlelines practiced by the school district.Loss /ISS/OSSJICA
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FightingFightStudent is involved in mutual participation in an incident involving physical violence.ISS/OSSJICDD
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Forgery/Theft/PlagiarismTheftStudent is involved by being in possession of, having passed on, or being resposible for removing someone else's property; or the student has signed a person's name without that person's permission, or claims someone else's work as their own.Restitution/Loss/ISS/OSS/ExpulsionJICDA (1 &2 & 21)
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Gang Affiliation DisplayGang DisplaySudent uses gesture, dress, and/or speech to display affiliation with a gang.ISS/OSS/ExpulsionJICF
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HarrassmentHarassThe delivery of disrespectful messages in any format related to gender, ethnicity, sex, race, religion, disability, physical features, or other protected class.ISS/OSS/ExpulsionJICDA (6 & 20)
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Inappropriate Display of AffectionInapp affectionStudent engages in inappropriate , consensual (as defined by school) verbal and/or physical gestures/contact, of a sexual nature to another student/adult.Loss/Detention/ISSJICDA (10)
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Inappropriate Location/Out of Bounds AreaOut BoundsStudent is in an area that is outside of school boundaries (as defined by school).
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Lying/CheatingLyingStudent delivers message that is untrue and/or deliberately violates rules.Loss /ISS/OSSJICDA (21)
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Physical AggressionPaggStudent engages in actions involving serous physical contact where injury may occur (e.g., hitting, punching, hitting with an object, kicking, hair pulling, scratching, etc.ISS/OSS/ExpulsionJICDD
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Property Damage/VandalismProp damStudent participates in an activity that results in destruction or disfigurement of property.Restitution/Loss/ISS/OSS/ExpulsionJICDA (1 &2)
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Skip ClassSkipStudent leaves or misses class without permission.Loss/ISSJICDA (10)
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TardyTardyStudent is late (as defined by school) to class or the start of the school day (and tardy is not considered a minor problem behavior in the school)Loss/ISSJICDA (10)
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TruancyTruanStudent has 10 or more "unexcused" abscenses in one year or 4 "unexcused" absences in one month.ISS/OSS/ExpulsionJICDA (11)
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Use/Possession of AlcoholAlcoholStudent is in possession of or is using alcohol.OSS/ExpulsionJICDA (12)
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Use/Possession of CombustiblesCombustStudent is/was in possession of substances/objects readily capable of causing bodily harm and/or property damage (matches, lighters, firecrackers, gasoline, etc.ISS/OSS/ExpulsionJICDA (11)
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Use/Possession of DrugsDrugsStudent is in possession of or is using illegal drugs/substances or imitations.OSS/ExpulsionJICDA (12)
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Use/Possession of TobaccoTobaccoStudent is in possession of or is using tobacco.OSS/ExpulsionJICDA (14)
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Use/Possession of WeaponsWeaponsStudent is in possession of knives (defined by school) and guns (real or look alike), or other objects readily capable of causing bodily harm.ISS/OSS/ExpulsionJICDA (11)
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PERCEIVED MOTIVATIONCodeDefinition
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Avoid Adult(s)Avoid aStudent engages in problem behavior(s) to get away from adult(s).
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Avoid Peers(s)Avoid pStudent engages in problem behavior(s) to get away from/escape peer(s).
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Avoid Task/ActivitiesAvoid taskStudent engages in problem behavior(s) to get away/escape from tasks and/or activities.
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Obtain Adult AttentionOb a attnStudent engages in problem behavior(s) to gain attention of adult(s).
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Obtain Items/ActivitiesOb itmStudent engages in problem behavoir(s) to gain items and/or activities.
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Obtain Peer AttentionOb p attnStudent engages in problem behavior(s) to gain attention of peer(s).
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OtherOtherPossible motiviation for referral is not listed above. Staff using this area will specify the possible motivation for this student's problem behavior.
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Unknown MotivationUnknownStudent engages in problem behavior(s) for unclear reasons.
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LOCATIONSCodeDefinition
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Art RoomArtThe area used for art classes and activities.
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Band RoomBandThe area used for band classes and activities.
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Bathroom/RestroomBathrmArea used by students for taking care of personal needs.
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BusBusThe area inside the bus.
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Bus Loading ZoneBux znThe area used for bus loading and unloading.
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CafeteriaCaféThe area used for breakfast and lunch.
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ClassroomClassAreas used for instructional purposes.
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Commons AreaCommonAreas shared by students and staff for specific activities.
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Computer LabCompArea used for group computer classes and activities.
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GymGymAreas used for physical educations activities.
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HallwayHallAreas designated for passing from one activity to another.
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LibraryLibraryThe area designated for research and study.
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Locker RoomLocker rmThe area used by students to prepare for and completing physical education classes and/or sporting events.
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Music RoomMusicThe area used by students for music activities (e.g., music class, choir)
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Off-CampusOffAn area beyond the property boundary of the school and not affiliated with a school activity.
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Office OfficeThe area used by school staff for primary school business and management.
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Parking LotPark lotAreas used for parking vehicles during school hours.
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PlaygroundPlygdThe outside area used for recess breaks.
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Special Event/Assembly/Field TripSpecial evtAreas used for infrequent actvities that occur in and/or out of school.
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StadiumStadiumArea used for athletic/special events (Powell Field)
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Unknown LocationUnknownThe location of problem behavior event is not know or undetermined.
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Ag ShopAgThe area of a school used for vocational classes and activities.
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Other LocationOtherThe location for problem behavior event occurs in a location that is not listed.
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ACTION TAKENCodeDefinition
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Bus SuspensionBus suspConsequence for Bus referral results in a period when student not allowed on bus.
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Community ServiceComm svcConsequence for referral results in involvment in community service activities or projects.
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Conference with StudentConfConsequence for referral results in student meeting with administrator, teacher, and/or parent (in any combination)
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ExpulsionExpulConsequence for referral results in student being dismissed from school for up to one calendar year.
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Individualized InstructionInstructConsequense for referral results in student receiving individualized instruction specifically related to the student's problem behaviors.
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In-School SuspensionIn-sch suspConsequence for referral results in a period of time spent away from scheduled activities/classes during the school day.
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Loss of PriveledgesLoss privConsequence for referral results in student being unable to participate in some type of priviledge.
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Out-of-School SuspensionOut-sch suspConsequence for referral results in a period of time when student is not allowed on campus.
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Parent ContactParentConsequence for referral results in parent communication by phone, email, or person-to-person about the problem.
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Restitution/Community ServiceRestitutionConsequence for referral results in apologizing or compensating for loss, damage, or injury; community services.
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Other Action TakenOtherConsequence for referral results in administrative decision that is not listed. Staff using this area will specify the administrative action taken.
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