STUDENT ASSISTANCE TEAM CHECKLIST (Administrators ONLY)

Your Name:     Name of Student:    Date: 

 

DISCIPLINE

ATYPICAL BEHAVIOR

INAPPROPRIATE BEHAVIOR

Number of Violations to date: 

 

Number of In-School Suspensions: 

 

Number of Referrals: 

 

Number of Out-of-School Suspensions:

 

Expulsion Hearing: 

Expresses desire to punish or gain revenge via violence

Expresses drug or alcohol use

Loss of co-curricular eligibility

Possible odor of alcohol

Possible odor of marijuana

 

Inappropriate dress

Misuse of passes

Obscene language or gesture

Physically aggressive towards others

Repeated cutting class

Verbally abusive

 

 

 

POLICY VIOLATIONS

HOME/SCHOOL/FAMILY INDICATORS

 

Assault/Fighting

Dress Code

Harassment

Possession and/or Tobacco Use

Possession and/or Alcohol Use

Possession and/or Drug Use

Possession of drug paraphernalia

Possession of look-a-like drug

Weapon possession

Involvement in theft

Selling or purchasing drugs or related items

Vandalism

 

 

 

Recent divorce/separation

Job loss of family member

Refusal to go home

Recent death of family member or friend

Does not live with parents