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ABojouypey z quepnig Bquaudinba jo asnsi panjosasun, Bujusee| eu Jo auSuIOWN quawuounus 3u1We2| | soyoiouequi payeodel, soley ‘aiqeyoee wEUIUON|AU sofew yno sy aug jo aoua.2y2qul quepnig AUONe|OIA JOU, panceauin eoueyep payeados, yno siiy pata squepns aoueyap anissaoxa (vopensny juepmg Jo/pue anne, ou) 6q Siu pinom ileeas | en 82) uyssai6de quayorn jequan quajoln-uou jeqien 4o/pue jeoishyd,, Joypue jea1skud, ‘eul| wonoq oul] eu Mo}Oq ul] woyoq oul «HPYD- 1 Jolewjouly e2g,,, cuone}oedxe perelo|A HEUD-L JofeWoul 8g, soyneyeq eul] WoROG 943 BuyAfonuy esuayo IsIy 4o1neyoq oul] WoHOG 2 JO oul] Ol Mojag B Siy) SEM SJUEPN}S OY} SILA SEM 2 JO Out] OL) Mojeg & SIL SEA (s)uoneyedxe sidd SO]EIOIA JUePNIS 6 ~YVHOMOT4 AMWNITdIOSiC Siad SIN} 10Procedural steps for issuing a Minor Misbehavior 1, Staff member fills out a minor form, gives one copy to the student to take home for parental signature and keeps the other copies. 2. Staff member emails the student’s homeroom teacher as soon as possible to let them know that the student has received a minor. 3, The student returns the parent signed copy of the minor to the PBIS mailbox in the main office by the following day. 4. Mrs. Nodorft will check the PBIS mailbox daily and notify the issuing teacher when the signed minor is returned to school. 5, Parent signed minor forms will be kept on file in the guidance office. Procedural steps for issuing a Major Misbehavior 1, Staff member fills out a Major Misbehavior form on a student. The staff member gives a copy to the student and keeps a copy. 2, The student will take a copy of the Major form home to be signed by a parent/guardian. 3, Staff member takes his/her copy of the Major form to the office at their earliest convenience. “*If the severity of the student's action requires immediate attention, the student will be sent directly to the office. 4, The office will seek the student to discuss the Major Misbehavior if it is necessary. 5, Signed Majors will be returned to the PBIS mailbox in the main office the following day. it6. Mrs. Nodorft will gather signed majors from the PBIS mailbox daily, and will notify the issuing teacher and Mrs, Savatski that the signed major has been returned. 7. Signed majors will be kept on file in the guidance office. 1aDarlington Elementary Middle School Office Discipline Referral Student _ Date Referred By ‘Time Homeroom Teacher. Grade Level Location af Incident: (Please choose) Classroom ___Cafeteria __Playground ___Hallway ___Bus ___Bathroom ___Other Behavior: (Report the most intrusive behavior) _——active and/or excessive deftance unresolved interference of the learning environment physical and/or verbal violent aggression unresolved misuse of equipment/technology unresolved issues: dress code violations, late work, unprepared for class, tardy/late for class bullying/harassment ___swearing, plagiarism /forgery, theft, property damage, vandalism issued with 3"! minor violation Possible Motivation: -—Obtain Peer Attention ___Avoid Peer(s)_ __Obtain Items/Activities ___Avoid Work Obtain Adult Attention ___Avoid Adults(s) ___Avoid 'Tasks/Activities ___ Other. Others Involved: None Peer(s) Staff ___Teacher Substitute Unknown Other Description of Incident: (For confidentiality, use only the name of the student listed at the top of this form.) Follow Up and Consequences: Conference with Student ___Parent/Guardian Contact In School Suspension for ___days Loss of Privilege Time Out: Classroom/Office —__Out of School Suspension for ___ days “Individual Instruction Restitution other Office Staff Signature & Titk Parent/Guardian Signature: Parents/Guardian: This misconduct report is being sent to inform you of your child's behavior. We appreciate your support and partnership as we work with your child to make positive changes to behavior. Ifyou have any questions, please cal the Darlington Elementary Middle Schoo! Office at 776-4021, ext 5. Please lave your child return this signed behavior incident report to school.