Disciplinary Referral Form
Grades 6-8 discipline Referral
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Referring Teacher's Name *
Teacher's Email Address *
Date of the incident *
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Grading Quarter *
Time of the incident *
Time
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Which referral are you submitting? *
Non-Negotiable Offenses: Drugs, Alcohol, Weapons, Threats against teacher/or physical assault resulting in serious bodily injury/verbal assault, Bully & Intimidation (or violating the stay away agreement), Sexual Assault, Gang related fights and other activity, Inappropriate use of electronic media, Refusing punishment, Student has STARTED (hit first) a fight for the FOURTH time 
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