Discipline Center Office

Suspension / Expulsion Recommendation Form

AP1 / AP3

INCIDENT INFORMATION

To the Parents of: ID Number:Grade: Date://

Address: City:Select OneBaton RougeBakerGreenwell SpringsPrideZachary State: Zip:

DOB// Race:Select OneBlackWhiteAmerican IndianAsianHispanicOther Sex:Select OneMaleFemale SP ED Exceptionality / 504:Select One:AutismDeaf - BlindnessDevelopmental DelayEmotional DisturbanceHearing ImpairmentMental DisabilityMultiple DisabilitiesOrthopedic ImpairmentOther Health ImpairmentSpecific Learning DisabilitySpeech or Language ImpairmentTraumatic Brain InjuryVisual ImpairmentGiftedTalented

Date parent was contacted by Principal/Designee:// Telephone:

Incident Referred by: Incident Time: Incident Location:
Thisis theSelect One1st2nd3rd4th5thOtherreferralfor the following reasons:

1.
2.

LUNCH: Select OneFreeReducedPaid

Parents must accompany students to the Discipline Center on the first day of assignment. Your child should attend the Discipline Center for all the days indicated above. The Discipline Center opens at 7:00 a.m. Students must arrive no later than 7:30 a.m. each morning and must be picked up promptly at 1:30 p.m. each afternoon. Transportation must be provided by the parent. Students must behave appropriately while at the Discipline Center and complete assignments as directed by their teacher and/or their moderator. If the student does not attend the Discipline Center the days will be counted as unexcused absences. Continued referrals to the Discipline Center could result in assignment to an alternative program.

AP1–SUSPENSION (Discipline Center Admission Form)

Your child has been assigned to the Discipline Center at SELECT A DISCIPLINE CENTER SITE:21 - Valley Park22 - Gus Young24 - Bogan Walk26 - Rosenwald28 - Monte Sano29 - Greenwell Springs Road30 - Flannery Road31 - Mohican Elementary Discipline Center34 - Drusilla Lane Elementary Discipline Center

BEGINNING DATE:// RETURN DATE: // NO DAYS:Select One12345678910PENDING HEARING

Reason Code:(01-14)01 - Willful Disobedience02 - Disrespect Authority03 - Makes Unfounded Charge against Authority04 - Uses obscene language05 - Immoral Practices06 - Injury To Others07 - Dangerous substance08 - Tobacco/Lighter09 - Alcoholic beverages10 - Disturbs school 11 - Vandalism to school12 - Writes Obscene Language13 - Possesses Weapon(s) (weapon type code is rqd)14 - Possesses Firearms, Knives (blade > 2.5 ") or (15-33)15 - Throws Missiles16 - Instigates or participates in Student Fight17 - Violates Traffic/Safety Regulations18 - Leaves school/class 19 - Habitually tardy/absent20 - Stealing21 - Commits any Other Serious Offense29 - Murder30 - Assault and Battery31 - Rape/Sexual Battery32 - Kidnapping33 - Arson or (34-43)34 - Criminal Damage to Property35 - Burglary36- Misappropriation with Violence to the Person37 - Carry\discharge weapon38 - Possesses pocket knife (blade less than 2.5")39 - Serious Bodily Injury40 - Use of Medication without Authorization41 - Possession of Body Armor42 - Bullying43 - Cyberbullying WEAPON TYPE:CHOOSE A CODE:02 - Gun03 - Firearm Silencer04 - Explosive05 - Projectile06 - Weapon Parts07 - Handguns08 - Rifles/Shotguns (# 13 ONLY)

School Administrator: Referring School: Referring School Site Code:

AP3– RECOMMENDATION FOR EXPULSION

Please complete AP3 section below and email ()

Date Parent was contacted by Principal/Designee //. Method of contact: Select OneRegistered Mail/PhoneRegistered MailConferenceLeft message on machineOther

Date of Hearing:// Time of Hearing: Your child’s hearing will be held at Select Oneyour child's schoolChoctaw Administrative CenterOtherby the Supervisor of Child Welfare and Attendance assigned to that school unless extenuating circumstances exist.

We regret that is has been necessary to take disciplinary action. If you desire further information concerning this matter, you may contact the school at the following telephone number: -. We are hopeful that our coordinated efforts will lead to better communication and a solution to the problem. Parents have the right to view all of the evidence presented by the school at the expulsion hearing.

Parent/Guardian Information

Name:

Address:

City: Select OneBaton RougeBakerGreenwell SpringsPrideZachary Zip:

Signatures: Hearing Officer ______Parent ______

cc: School Student/Parent Assigned Discipline Center Exceptional Student Services REVISED: 08/19/2011