Student Referral and Information Packet

Student Referral and Information Packet / 2016-17
/ Socorro Independent School District /

Intake Checklist

This checklist has been develop to better serve the needs of the student(s) while being served at KEYS Academy. This checklist is a tool to assist you with all the required DAEP forms that must be turn in before the student(s) intake date.

1. Fax the discipline referral to 851-7287 or email to to secure intake date. Date:

2. Schedule discipline hearing and notify parent. Obtain parent’s signature on discipline referral.

Hearing Date:

3. Obtain intake date from intake secretary(3 school days of fax date above): Intake Date:

Corresponding exit date:

4. Complete KEYS Academy Student Referral and Information Form and gather all needed information:

Copy of Current Grades-in-progress {Current Grades (Gradebook Contract)}

Transcript

Discipline history (when recommending placement due to persistent misbehavior)

Copy of PEIMS Special Programscoded in Tyler

*Teacher Notification and Feedback Forms

SPED/504Meeting Date: ______

ELL/LPAC Meeting held: ______

For Transfer/Re-Entry students, please ensure that original copies of the following items are on file in the blue folder.

Home Language Survey date: ______

HLS (signed when students first registered in Texas school)

Initial Placement OLPT Score/Data

Parent Notification of Placement

Initial Placement LPAC forms/PEIMS data which indicates LEP Status

Instructions

When referring a student to KEYS Academy, please follow these steps:

Fax a copy of the discipline referral as soon as possible to KEYS Academy at 851-7287 OR email a pdf copy as an attachment (recommended)to . If a parent signature hasn’t been obtained please make sure to provide a signed copy with all paperwork. Please include the incident case number if there is one associated with the referral (some offenses require administration to notify police services). It is extremely important to completely fill out the discipline referral, including Special Education information and when the parent meeting will be/was held so KEYS Academy administration can provide you with an intake and exit date prior to the parent meeting.
Schedule a discipline hearing with the parent as soon as your investigation determines a DAEP placement may be warranted. There is no need to wait for KEYS Academy administration to contact you before scheduling the parent meeting for mandatory placements. If the student is a special education student (verify with diagnostician), please schedule a manifestation determination ARD Meeting and invite the KEYS Academy administration/representative.

Suggested Agenda for Parent Meeting

(Using the Removal Conference Script from the SISD Discipline Handbook is recommended)

Introductions
Explanation of student’s Code of Conduct Violation, corresponding discipline options, and laws and policies related to violation (i.e. mandatory vs. discretionary placements, TEC Chapter 37, etc.) Remember, this is traumatic for parents. Try to put yourself in their shoes and understand their fears and concerns. DAEP placement is not every parent’s dream for their child.
Present case against student’s behavior and present witnesses.
Allow student and parents to present explanation or their defense and witnesses.
Notify parents of due process rights and procedures including appeal process.

At this point you can proceed with a decision or tell the parent you would like to consider your decision and will notify them via letter of your decision. If you decide to go forward with the DAEP placement during the hearing, you can continue with the following steps:

Explain student trespassing policy and present parent with Criminal Trespass Warning that you will keep on your campus.
Go over Intake form with parents and obtain initials and signatures where indicated.
Notify parent of intake/orientation date and projected exit date.
Explain students must be present at the intake in order to avoid unexcused absences and possibly truancy court.
Provide parent copies of all documentation.
Assist parents with withdrawal process and obtain signed withdrawal form
Adjourn meeting

3. After the discipline hearing with the parent, gather all needed documentation (included in the checklist) and the cumulative folder and send to KEYS Academy prior to intake date.

4. Expect confirmation the student attended the intake/orientation from KEYS Academy. If you do not hear from us after two (2) days of the scheduled intake/orientation date, please contact the campus receptionist at 937-4000 to verify whether or not the student attended their appointment.

*Please Note:

All required documentation must be complete with parent signature (or witness signature if parent refuses) and received by KEYS Academy within three (3) school days prior of the student’s intake date. If not, the student will be returned to the home campus. Forms are listed on the Campus Paperwork Checklist on page 1.

Student Referral Flow Chart

9-11 Week Placement Schedule

Home Campus Return Date: ______

Elective Course / Semester / Teacher / Packet Completed (Yes/No) / Teacher Signature / Date Received

Student Referral and Information Form

Student Name: ID: 0 Grade Level: Home Campus:

Referring Administrator: Phone:

Parent/Guardian Name:Street Address: Zip: 799XX Phone:

This student is being referred to KEYS Academy in accordance with the following Socorro ISD Student Code of Conduct discipline infraction (Please have parent/guardian initial on the corresponding blank lines).

A: Level 3 Discretionary PlacementP/G Initials ______.

(9 school week placement depending on offense).

B: Level 3 Mandatory PlacementP/G Initials ______

(9 school week placement).

C: Level 4 Discretionary Expulsion P/G Initials ______

(18-36 school week placement depending on offense; does not qualify for early exit if student has been previously placed at KEYS Academy in the same academic year).

D: Level 4 Mandatory ExpulsionP/G Initials ______

(180 school day placement depending on offense; does not qualify for early exit).

HEARING DECISION

______Student assigned DAEP placement at KEYS Academy(Complete all sections below).

______Student not assigned DAEP placement and will remain at home campus (Retain form in student’s discipline file).

SPED/504

S1 Student receives Special Education services and a Manifest Determination ARD was held on .

BIPwas updated at above ARD meeting and is attached (required if S1 is checked).

S2 Student receives 504 services and a Manifest Determination meeting was held on .

BIPwas updated at above ARD meeting and is attached (required if S2 is checked)..

S3 Student does not receive Special Education or Section 504 services.

ELL/LPAC

E1Student receives ESL services in the following classes: LPAC Meeting was held:

E2Student does not receive ESL services in class but is identified as ELL. LPAC Meeting was held:.

E3Student does not receive any bilingual/ESL or ELL services.

LOC

L1Student is currently being served for Loss of Credit. Attendance Committee Meeting date:

Contract and attendance history attached (required if L1 is checked).

L2Student is not under any type of attendance or Loss of Credit contract.

Student’s intake date:Click here to enter a date. At 9:00 a.m. P/G Initials ______

(Parents understand failure to attend intake may result in truancy charges filed against them with local government agency)

Projected exit date (Refer to intake schedule):Click here to enter a date.P/G Initials ______

Due Process and appeals rights and procedures have been explained to parents. P/G Initials _____

Other special needs/information: P/G Initials ______

Parent’s Signature ______Date

Administrator’s Signature ______Date

Witness/Other Signature ______Date

Updated by M.A. Rivera - Saturday, October 06, 2018, Page 1 | 2016-17