LCISD 2013-2014 DAEP PLACEMENT ORDER FORM

Name: / Grade: / ID#:
Race: / Gender: / Birth Date:
Campus: / Administrator: / Formal Conference Date:
Police Report: check YES or NO / Citation: check Class A CLASS C / Arrested: check YES or NO
DAEP Removal Offense: check YES or NO / Expulsion Offense: check YES or NO
Mandatory: check YES or NO / Discretionary: check YES or NO
Special Ed: check YES or NO / Disability: / Provide copies of ARD, IEPs, BIP …
504 Student: check YES or NO / Disability: / Provide copies of accommodations …
ESL student: check YES or NO / Provide copies of LPAC, Services provided …
Reason: / Code:
Check: 1st 2nd 3rd 4th 5th 6th 7th / Last date of most recent placement:
Grades 6 – 12 (check one below) / Ages 10+ (check one)
Level 2 – 45 school days (code AL): student withdraws / Expulsion - school days (code XJ) student withdraws
level 3 – 90 school days (code AM): student withdraws / Court Placement in JJAEP - school days (code AJ) student withdraws
Level 4 Expulsion - school days(code XA)student withdraws / No mandatory action taken due to ARD behavior link (code NO)
Court Placement in JJAEP - school days (code AJ) student withdraws / Age 6+ Grades K-5 (check one)
Discretionary Expulsion in JJAEP-school days(code XJ)student withdraw / Level 1 – 15 school days (code AS) student does not withdraw
No mandatory action taken due to ARD behavior link (code NO) / Level 2 – 30 school days (code AL) student does not withdraw
No mandatory action taken due to ARD behavior link (code NO)
ALC Start Date: / JJAEP Start Date:
Email documents to: Randal Donnell, Christopher Morse, Claudina Anderson, Kimberly Sydow, Api Nanes / Email documents to: Randal Donnell and Lorena Torres
Documents required: Approval form,class schedule, withdrawal grades, Graduation Plan, Sped/504/LPAC … / Documents required: class schedule, withdrawal grades, Graduation Plan, Sped/504/LPAC …
Notify Jennifer Roberts and send Victim Form when Class A Assault occurs. / Notify Jennifer Roberts and send Victim Form when Class A Assault occurs.
Notes:

SIGNATURES

Administrator: / Date:
Parent/Guardian: / Date:
Student: / Date:
Interpreter: / Date:
Other: / Date:

Form #7