UNION SCHOOL DISTRICT PARENT NOTICE OF SUSPENSION
DATE OF INCIDENT: ______DATE OF REPORT: ______STUDENT ID # ______INCIDENT ID:______
STUDENT’S NAME: ______BIRTHDATE: ______GRADE: ____ SCHOOL______
MALE: ___ FEMALE: ___ SPECIAL ED: YES___ NO___ 504 PLAN ___ (If yes, consult with Special Ed. Dept.)
PARENT #1 NAME: ______PHONE: ______
ADDRESS: ______CITY/ZIP: ______
PARENT #2 NAME: ______PHONE: ______
ADDRESS: ______CITY/ZIP: ______
THIS SUSPENSION: Number of days ______From (date) ______Return (date) ______
TOTAL NUMBER OF DAYS THIS SCHOOL YEAR WITH THIS SUSPENSION: ______
POLICE REPORT: Juvenile Hall ( ) County Jail ( ) Citation ( ) Info ( ) Case #____ Officer and Badge ______
EXPULSION RECOMMENDED: yes ____ no____
SUSPENSION IS REQUIREDOR AUTHORIZED[check all applicable]:
____Immediate suspension is required due to theoffense:Student committed a Category IOffense. (See below.) (Suspension requiredeven for a first time offense.)(Education Code,sec. 48915(c).)
____Suspension isauthorized due to the offense: Studentcommitted a Category II offense (see below) and/or violated Education Code, secs. 48900 (a), (b), (c), (d), or (e) (see below.)(Suspension allowed even for a first time offense.) (EducationCode, sec. 48900.5).
____ Suspension is authorizedbecause[check at least one and all that apply]:
____Other means of correction have failed to bring about proper conduct. (Education Code, sec. 48900.5)
Prior interventions: ______
____Presence of student causes a danger to persons or property. (Education Code, sec. 48900.5)
____Presence of student threatens to disrupt the instructional process. (Education Code, sec. 48900.5)
STUDENT COMMITTED THE ACT(S) INDICATED BELOW[checkall applicable offenses]:
Category I Offense – IMMEDIATE SUSPENSION AND MANDATORY EXPULSION: Principal/Superintendent shall immediately suspend and recommend expulsion, and the governing board shall expel(Education Code, sec. 48915(c)).
____(1) Possessed, sold or otherwise furnished a firearm
____(2) Brandished a knife at another person
____ (3) Unlawfully sold a controlled substance
____(4) Committed or attempted to commit a sexual assault or committed a sexual battery
____ (5) Possessed an explosive
Category IIOffense – SUSPENSION AND MANDATORY EXPULSION(absent administrator finding that inappropriate): Principal/Superintendentmay suspend and shall recommend expulsion,unless expulsion is inappropriate due to the particular circumstances (Education Code, sec. 48915 (a)).
____(1) Caused serious physical injury to another person, except in self defense
____(2) Possessed a knife or other dangerous object
____(3) Unlawfully possessed controlled substance
____(4) Committed robbery or extortion
____(5) Committed assault or battery upon a school employee
Category III – DISCRETIONARY SUSPENSION AND EXPULSION: Principal/Superintendent may suspend forviolation of Education
Code,secs. 48900 (a) – (t)and 48900.2, 48900.3, 48900.4 and 48900.7,and may recommend expulsion forviolations of Ed.Code,
secs.48900 (a) – (m)and 48900.2, 48900.3, 48900.4 and 48900.7, pursuant to Ed. Code,secs.48915(b) & (e) and 48900.7.
___(a)(1) Caused, attempted to cause or threatened to causephysical injury to another
____(a)(2) Willfully used force or violence upon another, except in self-defense
____(b) Possessed, sold or otherwise furnished a dangerous object
____(c) Unlawfully possessed, used, sold, or under influence of, a controlled substance
____(d) Offered, arranged or negotiated to sell and then sold, delivered or furnished actual or replica controlled substance
____(e) Committed or attempted robbery or extortion
____(f) Caused or attempted to cause damage to school or private property
____(g) Stole, or attempted to steal school or private property
____(h) Possessed or used tobaccoproducts
____(i) Committedobscene act or habitual profanity or vulgarity
____(j) Possessed, offered, arranged or negotiated to sell drug paraphernalia
____ (k) Disrupted school activities or willfully defied valid authority of teachers or other school personnel
____(l) Knowingly received stolen school or private property
____(m) Possessed an imitation firearm
____(n) Committed or attempted to commit sexual assault or committed a sexual battery (ALSO CHECK CATEGORY I (4) ABOVE.)
____(o) Harassed, threatened, or intimidated a student who is a complaining witness or witness in a school disciplinary proceeding
____(p) Unlawfully offered, arranged to sell, negotiated to sell or sold the prescription drug SOMA
____(q) Engaged in, or attempted to engage in, hazing
____(r) Bullied another student or school personnel, including by electronic act (e.g., cyber bullying)
____(t) Aided and abetted infliction or attempted infliction of physical injury on another person (expulsion permitted only if student adjudged by juvenile court to have aided and abetted an act of physical violence resulting in great or serious bodily injury)
____(EC 48900.2) Committed sexual harassment (grades 4-12)
____(EC 48900.3) Committed an act of hate violence (grades 4-12)
____(EC 48900.4) Harassed, intimidated or threatened studentsor District personnel (grades 4-12)
____(EC 48900.7) Made serious and credible terroristic threat against school officials or property
FACTUAL EXPLANATION OF INCIDENT:
Attachment 1: Student Incident Statement
Attachment 2: Administrator Incident Report
STUDENT CONFERENCE: ____Held ____Requested ____Via Phone ____Date ____ Time ____
___Not Held (due to emergency situation). Explain: ______
STUDENT’S SIGNATURE: ______
PARENT CONFERENCE: ____Held ____In Person ___Via Phone ____Date ____Time ____Phone Attempt
TO THE PARENTS: During the school day, your child must not be on or near the campus. Supervision is theresponsibility of the
parent or guardian.The reasons for this suspension have been explained to your child and he/she has had an opportunity to explain
his/her side of the incident. If you would like to discuss this suspension, you may request a meeting with the principal.
RELEASE TO A PEACE OFFICER: Your child was released under the supervision of ______on ______at______A.M. P.M.
Parent Notified by: ______Phone ___ In Person___ Mail ___ Home Visit ___ English ___ Other Language__Date_____
Suspended by: ______Principal ____ Designee ____Date: ______