Type of Note

Major Issue -Needs Immediate Follow Up
Data/Observation

Note Submitted By

Anastasia
Anne
Annette
Cheryl

Kate
Michele
Nancy
Neal
Rachel
Rebecca
Sam
Sandra
Saskia
Teresa

Location

Hallway - upstairs
Hallway - downstairs
Lobby
Kiva
Classroom
Office
Parking Lot
Off Campus
Bus

Description

Aggression
Defiance/Disrespect
Electronics/Communication
Horseplay
Inappropriate Language or Comments
Leaving Class w/o permission
Leaving School w/o permission
Abusive Language
Harassment/Bullying
Provoking Conflict
Disrupting Class
Vandalism
Smoking related
Drug related
Inappropriate Display of Affection
Lying
Cheating
Skipping Class

Description of the Event

Others Involved

Possible Motivation

Avoid Adults
Avoid Peers
Avoid Tasks/Activities
Obtain Adult Attention
Obtain Peer Attention
Obtain Items
Not sure

Describe how you responded to the student during the incident.

List the elements of the Student Action Plan in place that were accessed.