MEANINGFUL DISCIPLINE PLAN
PD Incident Report No:
(If Available) / Student’s Name:
Student Address: / Phone: / DOB:
Student ID: / Male / Female
Special Ed / Yes No / 504 / Yes No
School: / Ethnic Code: / Grade:
Education Code Violation(s): / Original Days of Suspension: / Reduced Days
of Suspension:
Expulsion/Transfer to Alt Ed Recommendation / Yes / No / Expulsion/Transfer Process Stayed due to
Restorative Justice/Meaningful Discipline plan participation: / Yes / No
Person Completing Form:
I understand that I have been suspended and/or recommended for expulsion for a California Education Code violation(s) (please refer to the suspension form for specific violation details violation details) and have agreed to participate in Sanger Unified’s Restorative Justice process.
Restorative Justice is an alternative to suspension/expulsion/involuntary transfer program that has been explained to me. In order to participate, I must accept responsibility for my actions as explained in the school report. I understand that if I choose to participate in the program but fail to complete the assigned alternatives to discipline by the date indicated that the original discipline as listed on the form will be reinstated. I further understand that this option may be withdrawn if the California Education Code continues to be violated.
YOUTH COURT
Youth Court referral (Must complete Youth Court referral form): Outline restorative justice plan in case Youth Court is determined to be inappropriate. Must contact Probation Officer to ensure space on calendar is available.
Restorative Justice/Meaningful Discipline Plan
Mandatory Components:
Maintain a 2.0 GPA
Obey all laws and school rules (including dress code)Maintain regular school attendance (97%)
If appropriate formal citation from Police Department will be requested if plan not completed by review date
Optional Components
(Drug testing required for all drug and alcohol related expenses)
Write an essay: Specific Topic:
Write an Apology to Victim(s) or others
Provide restitution to Victim(s) ______
Perform ______Hours of community service (1 – 40 hrs)
Participate in school-based activity(ies). Please specify and provide referral to student ______
Participate in school-based counseling program
Participate in conflict resolution
Pass drug testing (date of first required test 45 days from event)
Check in / Check out process for ______weeks with ______(school staff)
Attend mandatory tutorial
Participate in the Sanger Unified Family Focused Student Drug Intervention Program: (contact CWA for date)
Participate in Mediation
Other______
Other______
RESTORATIVE JUSTICEMEANINGFUL DISCIPLINE PLAN
Student’s Name:
/Student ID:
Review Hearing set for/continued for (30 days):
/at
/AM/PM.
At Review hearing, bring proof of restorative justice plan requirement(s)
Signature of Student:
/Date:
Signature of Parent/Guardian:
/Date:
Signature of Staff:
/Date:
REVIEW MEETING NOTES
Student Complied with plan, requirements met, case completed.
Student Failed to comply with plan original discipline reinstated. The following require not met.
Signature of Student:
/Date:
Signature of Parent/Guardian:
/Date:
Signature of Staff:
//
Date:
*Once complete a white copy MUST be submitted to CWQ with original hearing packet
Send copy to CWA Representative Page 1of 2 Rev. 10/27/4