Individual Student Records

Attachment I
Individual Student Records

Individual Student Records
School: _____________________________

District: _________________

Data for time period:

20 ___ ___
(year)

(beginning month)
Student’s ID #: ________________

to
(ending month)

Grade:

# of unexcused absences: _______

20 ___ ___
(year)

Date of Birth: ___/___/___

Date of enrollment in school: ___/___/___

# of excused absences: _______

# of days tardy: _______

Please complete the table below by indicating the number of times the student committed any of the Policy Violations listed. If a disciplinary
action was taken but the violation is unknown or not clear, please enter information under “Unknown” policy violations. Also, please indicate
the type and number of times a disciplinary action was taken or not taken for each violation. The total number of disciplinary actions should
equal the number of violations committed.

Other Disciplinary
Action (Please
Specify)

Transferred (e.g.,
to Alternative
School)

Expulsion

# of days

Out-of-School
Suspension

# of days

In-School
Suspension

Detention

Policy Violations

Number of Times
Committed Violation
in Targeted
School Year

No Disciplinary
Action Taken

Disciplinary Action

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

Page 1 of 1