Discipline Referral Form Grade 7 Gender M Student's Name Thaddeus Ledbetter Teacher's Name Location of Offense CCMS Reason s for Referral The True Emergency Drill Previous Corrective Action s Taken by Teacher Student Conference Times Referred to Counselor Time Out Loss of Privilege Behavior Contract Seating Change Letter Sent Home Phone Conference with Parent Face to face Conference with Parent Other Action s Taken by Administrator Discussion Verbal Reprimand Warning Probation Referred to Counselor Student Conference Detention Contacted Parent In School Suspension ISS Detention Expulsion D A E P Assignment Referral to Law Enforcement Other Administrator Signature Principal Frank Cooper Student Signature Thaddeus A Ledbetter soon to be Esq
