School Policy Violations and Disciplinary Actions

Attachment H
School Policy Violations
and Disciplinary Actions

School Policy Violations and Disciplinary Actions
Form completed by: ________________________________

Title: _______________________________

Phone number (including area code): _________________________

School Information
School: _______________________________________________________
District: _______________________________________________________

Grades in your school: (please circle all that apply)
5

6

7

8

9

Data are for the 8 week period:
20
(beginning month)
(year)

to

20
(ending month)

(year)

Total school enrollment as of October 1, 2006: ________

Students eligible for free and reduced-price lunch: #______ or %______
# of students who were tardy on the most recent school day: _____
# of students with unexcused absences on the most recent school day: _____
# of students with excused absences on the most recent school day: _____

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I. Policy Violations by Students
Column 1: # of violations committed by students
Provide the number of violations of each type that occurred on your school grounds, at school-sponsored events, or on school buses during the 20062007 school year. For each type of offense, indicate the number of violations (not the number of offenders). If multiple violations occurred in a single
incident, count each separate violation. For example, if a student was using alcohol and committed sexual harassment, count one violation for use of
alcohol and one violation for sexual harassment.
Columns 2-7: # of students committing the violations
Provide the number of students (offenders) committing each type of violation, by gender, grade and in total. For each type of violation, a student
should be counted at most one time, regardless of the number of times he or she committed that type of violation.
Enter 0 (zero) if no incidents have occurred or DK if the information is unknown or not available.

Policy Violations

# of Violations
Committed
by Students

# of Students Committing the Violations
Total

Male

Female

Grade 6

Grade 7

Grade 8

Bullying
Robbery
Physical attack on another person
Threat of physical attack on another person
Theft
Possession of a weapon
Possession, distribution, or use of alcohol or illegal drugs
Sexual harassment
Vandalism
Other (specify):
Other (specify):

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Hate Crime and Gang-related Crime
Following the instructions above, report the number of violations and the number of students committing these violations for hate crimes and gangrelated crimes. These violations may or may not include violations reported in the above table.

Policy Violations

# of Violations
Committed by Students

# of Students Committing the Violations
Total

Male

Female

Grade 6

Grade 7

Grade 8

Hate crime
Gang-related crime
Other (specify):

II. Disciplinary Actions Against Students
Please provide the number of detentions, in-school and out-of-school suspensions, expulsions from school, and transfers to specialized schools for
students during the 8 week period indicated. If more than one student was disciplined for a given incident, please count each student separately when
providing the number of disciplinary actions. If a student was disciplined more than once during this time period for different offenses, count each of
those disciplinary actions separately. However, if a student was disciplined in several ways for the same offense (for example, the student was first
suspended and then removed from school), count only the most severe disciplinary action that was taken for that offense.

Number of Students Disciplined
Disciplinary Action

Total

Male

Female

Grade 6

Grade 7

Grade 8

Detention
In-School Suspensions
Out-of-School Suspensions
Expulsions
Transferred (e.g., to Alternative School)
Other (specify):

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