Note: The completed form must be kept on file in the school. The principal must promptly submit a copy of this form to the superintendent.
Utilization of Preliminary Determination Provision
If the school district’s policy permits the use of a preliminary determination for reports of HIB, question 1 and 2 below must be completed on every form. School districts who do not permit the use of a preliminary determination for reports of HIB, should leave this section blank.