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Report on Expulsion

The document is a report template for Monroe Public Schools detailing student behavior incidents that may lead to expulsion. It includes sections for student information, incident details, disciplinary actions, and relevant policies. The report aims to ensure proper documentation and adherence to school regulations regarding student conduct.

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Francisco Rojo Rojo
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6 views

Report on Expulsion

The document is a report template for Monroe Public Schools detailing student behavior incidents that may lead to expulsion. It includes sections for student information, incident details, disciplinary actions, and relevant policies. The report aims to ensure proper documentation and adherence to school regulations regarding student conduct.

Uploaded by

Francisco Rojo Rojo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Monroe Public Schools

REPORT ON STUDENT BEHAVIOR


THAT MAY RESULT IN EXPULSION

Submission Date of This Report:


School: ____________________________
Principal:

Student Information:

Student’s Name in Full:


Student’s Age:
Date of Birth:
Grade Level:
Parent(s) Name(s):
Address:

Phone number:

Special Education Status (check one):


1. _____ Never received special education services.
2. _____ Never received special education services but had a PPT to consider placing the
student into special education. Explain:
3._____ Not receiving special education services now but was receiving special
education services in the past. Explain:
4. _____ Is receiving special education services. State the exceptionality:

504 Status (check one):


1. _____ Never received 504 services.
2. _____ Is receiving 504 services. State the 504 accommodations:

Date scheduled for manifestation determination PPT/504:

Manifestation determination PPT/504 is scheduled before the student is schedule to


return from a suspension that may have been imposed. _____ yes ____no

Results of manifestation determination PPT/504 attached: _____ yes ____no

Important Events:
Date and Time of Incident:
Date and Time of Direct: ________________________
Contact with Parents:
REPORT ON STUDENT BEHAVIOR THAT MAY RESULT IN EXPULSION Page 2

1st day of Suspension: _______________ 10th day of Suspension: _______________


Police Action Taken:

Date and Time when Police were Contacted:


Police Action Taken:
Police Report Attached: yes ____no

Date and Time of Direct Contact with Superintendent:


Date of Due process Regarding Incident with Student:
Date of Notice to parents of potential Expulsion Proceedings:
Direct oral communication:
Registered, return receipt requested letter sent on:

Witness(es): not applicable

NAME POSITION REPORT


ATTACHED

____________________________________________________ _____YES ____NO

____________________________________________________ _____YES ____NO

____________________________________________________ _____YES _____NO

____________________________________________________ _____YES _____NO

Type of Incident – Check All That Apply:


See Board of Education Policy 5114 & Regulation 5114.1

1 Willfully striking or assaulting a student or any member of the school staff


2 Conduct causing a threat or danger to the physical well-being or self or
others
3 Theft or attempting to steal private or school property or attempting to take
personal property/money from any person by means of intimidation
4 Use, either spoken or written on clothing, of obscene or profane language or
gestures to a member of the school staff or at school-sponsored activities
5 Deliberate refusal to obey authority
6 Intentional incitement which results in an unauthorized occupation of, or
walkout from, any school building, school premises, facility or classroom by
any group or students or other persons
7 Participation in any walkout from a classroom or school building by any
group of students and effusing to immediately return to said classroom or
school building after having been directed to do so by the principal or person
in authority
8 Intentional and successful incitement of truancy by other students
REPORT ON STUDENT BEHAVIOR THAT MAY RESULT IN EXPULSION Page 3

9 Blackmailing, threatening, or intimidating another person


10 Possession of a deadly weapon, dangerous instrument or weapon facsimile of
any kind including, but not limited to, a pistol, knife, blackjack, martial arts
weapon, etc.
11 Unauthorized entrance to any school facility or aiding or abetting
unauthorized entrance to of any part of any school, school premise, or
building owned by any school district
12 Possession of a firearm as defined in 18 U.S.C. 921, which is any weapon
that can expel a projectile by an explosive action and includes, explosive
devices, incendiaries, poison gases, and firearm frames, receivers, mufflers,
or silencers. Possession of a firearm as defined by C.G.S. 53a-3 includes a
sawed-off shotgun, machine gun, rifle, shotgun, pistol, revolver, or other
weapon from which a shot may be discharged, or a switchblade knife, a
gravity knife, billy, black jack, bludgeon or metal knuckles
13 Ignition of fireworks or explosives or ignition of materials which cause a fire
14 Possession of paraphernalia used or designed to be used for consumption,
sale, or distribution of tobacco, drugs, narcotics, or alcoholic beverages
15 Willful destruction of school property, including defacing property, or
property of staff members or other students
16 Accumulation of offenses such as tardiness, class or study hall cutting, or
failure to attend detention or repeated unauthorized absence from school
17 Unauthorized possession, distribution, selling, or consumption of alcoholic
beverages, dangerous drugs or narcotics
18 Making false bomb threats or other threats to the safety of others.
19 Defiance of school rules and/or repeated violation of generally accepted
school rules and practices that makes the violator seriously disruptive of the
educational process and/or a danger to others
20 The use or copying of the academic work of another and the presenting of it
as one’s own without proper attribution
21 Unauthorized and/or reckless and/or improper use of motor vehicle
22 Unauthorized use of any school computer or computer system, computer
software, Internet connection, or similar school property or system.
23 Hazing
24 Any action prohibited by any Federal or State law which would indicate the
student presents a danger to a person or property
REPORT ON STUDENT BEHAVIOR THAT MAY RESULT IN EXPULSION Page 4

Description of the Incident:

What Happened:
Incident Report Attached? ______yes _____no
Map:

Is the map included? _____yes no

Violator’s Report

Is a description of the incident from the violator’s point of view attached?


_____yes no

Disciplinary Action Taken:

Violation:
Date:
Punishment:

Total number of suspensions this year including suspension


resulting from this violation: _____ days
Total number of days out of school due to being suspended this
year including a suspension resulting from this violation: _____ days

Board and School Rules:

Copy of relevant Board Policies attached


Copy of relevant School Rules attached

How are students made aware of these rules? _________________________________


______________________________________________________________________
Date for pre-meeting with the superintendent. _________________

Date Set for Expulsion Hearing:

Was the expulsion hearing date set on or before the student is


scheduled to return from a suspension? yes no

If the expulsion hearing is scheduled for a date after a suspension is over,


has the student been receiving home-bound instruction? yes no

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