Suspension Or Expulsion Of A Special Education Student - Merced County Office Of Education
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1
2District:
MERCED COUNTY CALIFORNIA
School:
SPECIAL EDUCATION
LOCAL PLAN AREA
Teacher:
SUSPENSION OR EXPULSION OF A SPECIAL EDUCATION STUDENT
Student Name: Last
First
Birth date ____-____-____ Grade
Parent Name
Parent Address
Check one
nd
Suspension (2
suspension for IWEN – see back)
Effective date of disciplinary action:
____-____-____
Expulsion (For IWEN – see back)
Number of days action is in effect:
Decision by:
10 School or district personnel
30 Hearing Officer-for likely injury
Cumulative number of days to date:
20 Court order
31 Hearing Officer-any other reason
REASON(S) FOR DISCIPLINARY ACTION
Indicate at least one, but no more than three, reasons for the disciplinary action by checking
the appropriate column:
Reason 1
Reason 2
Reason 3
Code
Description
30*
Serious physical injury – threatened, caused or attempted to cause to another person
31
Force or violence - willfully used on another person
24
Assault or battery upon any school employee
11*
Knife - brandished at another person
32*
Firearm, knife, explosive, or other dangerous object – possessed, sold, or furnished
42
Firearm, imitation - possessed
33*
Controlled substance - unlawfully possessed, used, sold, furnished, or was under the influence of
34
Controlled substance - sold or delivered material represented to be
39
Drug paraphernalia - unlawfully possessed, offered, or arranged to sell
23*
Robbery or extortion
35
Property, school or private - caused or attempted to cause damage to
36
Property, school or private - stole or attempted to steal
41
Property, school or private - knowingly received stolen
37
Tobacco or nicotine products - possessed or used
38
Obscene act or habitual profanity or vulgarity - committed or engaged in
40
Authority - willfully defied or disrupted school activities
13*
Sexual assault or battery - committed or attempted to commit
50
Sexual harassment - engaged in
52
Harassment, threats, or intimidation - against a pupil or group of pupils or a pupil who is a witness
51
Hate violence, act of - attempted to cause, threatened to cause, or participated in
53
Terrorist threats - made against school officials or school property
*Incidents marked with a star in the Code column may be grounds for mandatory expulsion under certain circumstances.
STATUS OF THE STUDENT AS A RESULT OF THE DISCIPLINARY ACTION
Indicate no more than one result of the disciplinary action by checking
the appropriate box
Code Description
Code Description
Code Description
10
In-school suspension
33
Adult education program
44
Charter school (operated by an LEA)
20
Sent home, without instructional support
34
Independent study
45
Charter school (operated as an LEA)
21
Sent home, with instructional support
40
Juvenile court school
50
Graduated
30
Continuation class/school
41
County court school
51
Left district or moved
31
Opportunity class/school
42
Other county program
52
Dropped out or placement unknown
32
Community day school
43
Placed in another district
80
Other alternative education setting
Incident: Date _____-_____-_____ Time
Location
Witnesses:
Reported by:
Factual Description of incident(s):
Reported to Administrator: Name
Position
Date ____-____-____ Time
Contact with Parent/Guardian: By whom
Date ____-____-____ Time
Parent Conference: Date ____-____-____
Attendees: Administrator
Psychologist
Other information:
For more information, please contact the person completing this form:
____-____-____
Name
Position
Phone
Date
E
410a&b
SUSPENSION / EXPULSION
❒
❒
❒
❒
❒
07/01
Check copies provided:
Office/Pupil File
Classroom File
Parent/Guardian
Other _____________
Other _____________
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