Desktop Schools Popup

Series 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_____________________________________

Video Camera in Use?  ❏ Yes   ❏ No       Driver Witnessed?  ❏ Yes  ❏ No            Bus Patrol Witnessed?  ❏ Yes  ❏ No 

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, in accordance with Administrative Regulation 503.3AR, Student Behavior Expectations and Consequences for Misbehavior.

DRIVER ACTION TAKEN PRIOR TO REFERRAL (to be completed by driver)

❏ Gave student verbal warning (circle number of warnings)  1  2  3

❏ Assigned student to a seat              ❏ Checked student’s previous misbehaviors in district vehicle

REASON(S) FOR REFERRAL (to be completed by driver)

 

❏  Improper boarding/departing

❏ Not remaining in seat

❏  Interference, disruption or obstruction

❏  Abuse: verbal, written or otherwise                 expressed

❏  Tobacco and E-cigarettes, possessing

❏  Harassment

❏  Use of nuisance and/or recording devices

❏  Pushing, shoving or scuffling

 

 

❏  Records or identification falsification

❏  Weapon or look-alike weapon possession

❏  Fighting

❏  Tampering with or damage of emergency       or safety equipment

❏  Throwing, shooting or spraying of                 objects or propellants

❏  Damage of or tampering with property         [vandalism]

❏  Eating/drinking on the bus

 

❏ Other (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 expelled 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.

White:  Parent/Guardian        Yellow:  School        Pink:  Transportation

procedure/707.2.5.2P/10-09-19