Adopted: May 1980
Revised: June 2023
Download 707.2.5.2P - Referral for Student Misbehavior in District Vehicle, Grades Preschool-12
Student Name_________________________________________________ Grade__________ School_________________________________________________________
Date of Incident______________ (a.m.)(noon)(p.m.)(act.) Bus No.___________ Driver_____________________________
Driver/Chaperone Witnessed? n Yes n No Bus Patrol Witnessed? n Yes n No, Patrol Student ID number:
NOTICE TO PARENTS – This report is to inform you of your son’s or daughter’s misbehavior in a district vehicle. You are urged to support the action taken by the staff and to cooperate with the corrective action initiated today. Riding a district vehicle is a privilege which may be revoked when the safety of students, staff or motorists is jeopardized. Misbehavior in a district vehicle may also result in suspension or expulsion from school or other consequences, in accordance with Administrative Regulation 503.3AR, Student Behavior Expectations and Responses for Behavior.
DRIVER ACTION TAKEN PRIOR TO REFERRAL (to be completed by driver/chaperone)
Gave student verbal warning (circle number of warnings) 1 2 3
Assigned student to seat number:
REASONS FOR REFERRAL (to be completed by driver/chaperone)
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Other conduct prohibited by Administrative Regulation 503.3AR (specify)
SYNOPSIS:
SCHOOL PROCEDURE – The principal or designee, or Transportation Student Conduct Specialist will talk with the student, send a copy of the referral to the student’s parent or guardian, and take appropriate disciplinary action.
TO BE COMPLETED BY PRINCIPAL OR STUDENT CONDUCT SPECIALIST,
THEN SIGNED AND RETURNED BY PARENT OR GUARDIAN TO THE SCHOOL
- Conference with student on ________________ (date) Comments
- Parent/guardian contacted on ____________ (date) by: telephone personal conference__________________________________ referral sent
- Student suspended from vehicle for __________ (days) starting on _________________ (date)
- Student expelled from vehicle from __________________________ (date) to ___________ (date)
- Student given in-school suspension for __________ (days) starting on ______________ (date)
- Student given out-of-school suspension for __________ (days) starting on (date)
- Student referred for expulsion from school from __________ (date) to _______________ (date)
- Other response (specify)
Signature of Principal/Student Conduct Specialist Date __________________________________________________________________________
Signature of Parent/Guardian Date __________________________________________________________________________
Parent/Guardian: Please sign and return to school. Thank you.