Sample Discipline Data Form 2005-2006

DATA FORM Discipline Data Form--August 2011- 2012

Date ___/_____/______Student Number ______Incident Number______Grade______

Referred By ______Student Name ______/______DOB___/___/___ Last First

Enrolled Div. No. ______Enrolled School No. ____Offense Date ____/____/____ Incident Div. No..______

Incident School No. ______Parent Contacted (Telephone/Time)______

Location of Infraction______

Offense Sanction ______Days ______LEP ______Hispanic Y/N_____ Race _____ Code Primary Off. 2 Off. 3 Gender ______Firearm ______Non Firearm______Special Time Edu. Law ______Victim ______Alt. Placement ______

Special Education Codes: 02-SD; 03-MD; 04-OI; 05-VI; 06-HI; 07-SLD; 08-ED; 09-SLI; 10-OHI; 12-DB; 13-Aut; 14-TBI; 15-504; 16-DD; 19-ID Time Elements: 01-During school day; 02-School sponsored event 03-Non-school sponsored event; 04-In transit

LEGEND – Law Enforcement Suspension and Expulsion only * Persistently Dangerous New Code

Alcohol Breaking and Entering/Burglary DR1 or DG5 Synthetic Marijuana – Use AL1 or AC1. Alcohol Use BR1. or BK1. Burglary/Actual or Possession AL1. or AC2. Alcohol BR1. or BK2. Burglary/ DR4 or DG6 Synthetic Marijuana – Possession Attempted Distributions or Sale AL1. or AC3. Alcohol Sale or DR3. Theft or Attempted Theft of Distribution Prescription Medication Bullying Electronic Devices/Inappropriate BU1. Bullying Arson/Actual/Attempted BU2 Cyber Bullying Use AR1. or AS1. Arson Actual C1M. Beepers AR1. or AS2. Arson Attempted C2M. Cellular Telephones Disorderly Conduct C3M. Other Electronic Devices AR1 or AS3. Lighted Firecrackers/ D1C. Disrespect/Walking Away Cherry Bombs/ D2C. Defiance/Refuses Request Extortion Stink Bombs/ D3C. Disruptive Demonstrations EX1. or ET1. Extortion Contribute to a D4C. Possession of Obscene/ EX1. or ET2. Attempted Damaging Fire Disruptive Literature Extortion D5C. Classroom/Campus Disruption Assault/Battery D6C. Obscene/Inappropriate Fighting/Conflict * BA1. Assault/Battery/ Language/Gestures FA2. Fighting/No or Minor Firearm or Other D8C. Minor Insubordination Injury/Mutual Participation Weapon/Staff F1T Altercation/confrontation/No Injury BA2. Assault/Battery/No Drug Violations Gambling G1B. Gambling Weapon/Staff D4G. Over the Counter Med\Use * BA3. Assault/Battery/Firearm or D5G. Over the Counter Med/Possession Other Weapon/Student D6G. Over the Counter Med Gang Activity BA4. Assault/Battery/No Sale/Distribution Weapon/Student GA1. Gang Activity D15. Possession of Inhalants Harassment * BA5. Maliciously Wounding D16. Use of Inhalants without Weapon HR1. Harassment DR1. or DG7. Marijuana Use Hazing Attendance DR1. or DG8. Marijuana H1Z Hazing A1T. Attendance - Violations of Possession State, School Division or DR1. or DG1. Schedule I & II Use Homicide School Policy relating to DR1. or DG2. Schedule I & II Poss. *HO1. Homicide vs. Staff/Firearm Attendance * DR4. or DG3. Schedule Sales and *HO2. Homicide vs. Student/Firearm Distribution *HO3. Homicide vs. Staff/Other * DR4. or DG9. Marijuana Sale/Distribution Bomb Threat/Terrorist/ Weapon DR5. or D10. Other Drug Use/Overdose Chemical/Biological *HO4. Homicide vs. Student/ DR5. or D11. Other Drug Possession/ BB1. or BO1 Bomb Threat Other Weapon BB1. or BO2 Chemical/ Paraphernalia Possession Biological DR5. or D12. Other Drug Sale/Distribution Threat DR2 or D17. Substances Represented as Inciting a Riot BB1 or BO3 Terrorist Threat Drugs (Look-alikes) RT1. or RG1. Inciting a Riot BB1 or BO4 Setting off False * DR4. or D19. Anabolic Steroid Sale/Dist. RT1. or RG2. Attempting to Fire Alarm DR1. or D20. Anabolic Steroid Use and Poss. Incite a Riot Kidnapping TB1. or TC3. Tobacco Sale/ 15 Black or African Am. & Nat. Hawaiian *KI1. Kidnapping Distribution 16 Nat. Hawaiian & White Tobacco Offenses 17 Am. Ind./Alaska Nat., Asian & Black or African Am. Other Violations T4B Bringing Tobacco Paraphernalia to School 18 Am. Ind./Alaska Nat., Asian & White S1V Inappropriate Personal or School Event 19 Am. Ind./Alaska Nat., Asian & Nat. Hawaiian Property Trespassing 20 Asian, Black or African Am. & White S2V Misrepresentation 21 Asian, Black or African Am. & Nat. Hawaiian TR1. Trespassing Other Violations 22 Black or African Am., White & Nat. Hawaiian S3V Other School or Code of 23 Black or African Am., Nat. Hawaiian & Am. Conduct Violation not Vandalism Ind./Alaska Native otherwise included VA1. or VN1. Vandalism of School 24 White, Black or African Am. & Am. Property Ind./Alaska Native Robbery/Person/Force VA1. or VN2. Vandalism of Private 25 White, Nat. Hawaiian, & Am. Ind./Alaska or Threat of Force Property Native *RO1. or RB1. Actual VA1. or VN3. Graffiti 26 White, Nat. Hawaiian, & Asian *RO1. or RB2. Attempted 27 Am. Ind./Alaska Nat., Asian, Black or African Am.& White Weapons 28 Asian, Black or African Am., White & Nat. Stalking WP0. Pneumatic Weapon-BB, Hawaiian ST1. Stalking Pellet, or Paint Ball Gun 29 Black or African Am., White, Nat. Hawaiian & * WP1. Weapon Handgun/ Am. Ind./Alaska Native Pistol 30 White, Nat. Hawaiian, Am. Ind./Alaska Native Sexual Offenses * WP2. Weapon Shotgun/Rifle & Asian SB1. Sexual Battery against W3P. Toy/Look-alike Gun to 31 Nat. Hawaiian, Am. Ind./Alaska Native, Asian Staff School/Event & Black or African Am. SB2. Sexual Battery against W1P Possession of Ammunition 32 Am. Ind./Alaska Nat., Asian, Black or Student W2P Possession of Chemical Substance African Am., White & Nat. Hawaiian SX0. Sexual Harassment * WP4. Weapon, Expels a SX1. Offensive Sexual Projectile Touching/Staff WP5. Knife to School/Event Codes Requiring Victim Counts SX2. Offensive Sexual * WP6. Possession of Explosive BA1 HO1 SB1 SX6 TI1 Touching/Student Device/Live Ammunition BA2 HO2 SB2 SX8 TI2 *SX3. Sexual Assault Staff/Rape * WP7. Use of Bomb or Explosive BA3 HO3 ST1 TH1 BU2 *SX4. Sexual Assault Device BA4 HO4 SX0 TF1 Student/Rape * WP8. Zip Gun/Starter Gun/Flare BA5 HR1 SX1 TF2 *SX5. Attempted Sexual Gun BU1 KI1 SX2 TF3 Assault/Staff/Rape WP9. Other Weapons EX1 RO1 SX3 TF4 *SX6. Attempted Sexual WT1. Taser ET1 RB1 SX4 TH2 Assault/Student/Rape WS1. Stun Gun ET2 RB2 SX5 TF6 SX7. Sexual Offense w/out W8P. Razor Blades, Box Cutter, knife (less H1Z Force/Lewd Behavior/ than 3 inches) School/School Event SX7 May or may not have victim count Indecent Exposure W9P. Fireworks/Firecrackers/Stink *SX8. Aggravated Sexual Bombs at School/School Event (Revised 8-22-2011) Battery/Student less

than age 15 Sanction Codes 01 = Special Ed. In-School Suspension Technology Use Violations 02 = Short Term (1 to 10 days) T1C. Unauthorized Use of 03 = Long Term (11 to364 days) Technology or Information 04 = Expulsion (365 days) T2C. Causing/Attempting to 05 = Special Ed. Weapons and Cause Damage to Drugs only (1 to 45 days) Computer/ 06 = Special Ed. (VA Supreme Ct.) Hardware, Software/Files 07 = Used with Offense Codes WP1, T3C. Violation of Acceptable WP2, WP4, WP6, WP7, WP8, Use Policy DR1, DR4 (0-364days) T4C. Violation of Internet Policy 08= Special Ed.--IEP Permanent Change in Placement (0 days) Threats/Verbal/Physical 99 = Other than Suspension or TI1. Threat/Intimidation vs. Expulsion (0 days) Staff/Physical/Verbal TI2. Threat/Intimidation vs. Racial/Ethnic Codes Student/Physical/Verbal 01 American Indian/Alaska Native 02 Asian Theft/No Force 03 Black or African American TH1. or TF1. Theft/School Property 05 White TH1. or TF2. Theft/Staff Property 06 Native Hawaiian/Other Pacific Islander TH1. or TF3. Theft/Student Property 07 Am. Ind./Alaska Nat, & Asian TH1. or TF4. Possession/ Stolen 08 Am. Ind./Alaska Nat. & Black or African Property Am. TH2. or TF6. Attempted Theft or Theft 09 Am. Ind./Alaska Nat. & White of Motor Vehicle 10 Am. Ind./Alaska Nat. & Nat. Hawaiian 11 Asian & Black or African Am. Tobacco Offenses 12 Asian & White TB1. or TC1. Tobacco Use 13 Asian & Nat. Hawaiian TB1. or TC2. Tobacco Possession 14 Black or African Am. & White