Subject: DPHES DISCIPLINE REPORT
From: <Saved by Windows Internet Explorer 7>
Date: Sat, 26 Jan 2008 12:51:51 -0800

JSES DISCIPLINE
REPORT

First
Name:_____________________
Last Name:_________________
Date:_______

Grade:________  Teacher:
__________________________________
Rm #: ________

Reporting
Party:
________________________

Rule(s)
violated:

[ ]  I will walk and use a quiet voice in
designated areas and at designated times.

[ ]  I will follow directions the first time.

[ ]  I will act in a safe manner showing
respect for myself, others and
property.

[ ]  I will be on time, responsible and
prepared for school.

Consequences and student actions that
trigger them:

Green
card:  warning

Yellow
card:  loss of
recess

Orange
card:  time out to room #
_____

Red
card:  loss of
privilege/detention

White
card:

Parent
contact made on: ________________ at: ____________ phone:
______________

Summary:

Principal’s actions:

[  ] student conference
[  ] parent
conference

[  ] parent phone conference
[  ] office time
out

[  ] loss of recess/privilege
________________________________________

[  ] in-school suspension ½ day

[  ] in-school
suspension