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LEARY ISD
Administration
Discipline Notice
Discipline Notice
Discipline Form - Initial
Please Email yourself a copy of this form submission for your records.
Please Fill Out The Discipline Notice Below
Referring Staff
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Date
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Time
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Student's First Name
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Student's Last Name
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Grade Level
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Location of incident:
Auditorium
Bathroom
Bus
Bus Loading Zone
Cafeteria
Classroom
Commons
Gym/Locker Room
Hallway
Library/Media Center
Office
Parking Lot
Playground
Special Event/Field Trip
Stairs
Inappropriate Behavior
Bullying
Cheating
Defiance
Disrespect
Disruption of class/school
Dress code violation
Inappropriate language
Lying
Physical contact
Skip class/truancy
Tardy
Teasing
Disciplinary Action
Change seating
Conference with Parent
Detention
Loss of privilege
Parent contact
Time in office
Other
Other
If other please specify
If Detention was assigned, enter the date and time.
Date
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Time
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If the Parent was contacted, enter the date, time, and method of contact.
Date
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Time
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Method of Contact
Email
Home visit
Letter (mail)
Letter (via student)
Phone call
Enter any comments here.
Email a copy to
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