Student Related Incident Report

Please fill in all fields as necessary

Date and Time of Incident*
:  
Date of Incident (YYMMDD) and last 4 of Student ID
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Please select the option you feel best fits the offense.
Please select the option you feel best fits the offense.
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Your name*

Parties Involved...

Parties Involved 1
Parties Involved 2
Parties Involved 3
Any of the students involved in Special Education?
Name of Special Education Student
Please provide details based on observations you have made and know to be factual
Were the student(s) given an opportunity to write a Student Statement?
No File Chosen
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Were the parents contacted?
Spoke with parents?
Were the Police contacted?

Recommendation for Suspension

Do you wish to recommend suspension?
Action Taken By (choose one):*
Please provide a phone number for any follow up regarding this incident.
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