<p> Las Cruces Public Schools SHORT-TERM SUSPENSION</p><p>INSTRUCTIONS: 1. Use this form for online entry or suspension or health-related exclusion. 2. Suspensions of more than 10 days, or request for long-term suspension/expulsion, must be processed through the Office of the Hearing Authority. 3. Short-Term Suspension Form (JKD-E1) is not necessary if you are pursuing long-term suspension/expulsion. First Day Student Name:______Student ID #______of Suspension ______/______/______Month Day Year Student Address: ______Phone ______or ______</p><p>School Name ______Responsible Administrator ______</p><p>Name of staff member referring student: ______Police Report #______(if applicable)</p><p>STUDENT INFORMATION</p><p>Age ______Grade ______Sex: □Male □Female IEP: □Yes □No 504 Plan: □Yes □No</p><p>REASON FOR SUSPENSION (Use codes from SUSPENSION OFFENSES WITH CODES) * See LCPS Discipline, Violence, and Vandalism Incident Reporting System</p><p>Primary Suspension Complete Type of Weapon /Explosives with related codes: Supplemental </p><p>A. Discipline Plan Violations: (if applicable) Category A: Offense Number 1 □ 2 □ 3 □ Category B: Offense Number 1 □ 2 □ 3 □ Description: ______Description: ______</p><p>Category C: Offense Number 1 □ 2 □ 3 □ Category D: Offense Number 1 □ 2 □ 3 □ Description: ______Description: ______</p><p>Category E: Offense Number 1 □ 2 □ 3 □ Category F: Offense Number 1 □ 2 □ 3 □ Description: ______Description: ______</p><p>B. Discipline Plan Violations: (if applicable) Policy Violation Title: ______Policy Violation Number: ______</p><p>TERMS OF SUSPENSION – Record number of days Example: 1 day 1.0 ½ day 0.5 Days of Suspension</p><p>Out-of-school ______In-school ______Beginning Date ______End Date ______</p><p>Additional Information (if needed): ______</p><p>SIGNATURES REQUIRED AT THE TIME OF EACH VIOLATION</p><p>______Student Signature Date Parent/Guardian Signature Date</p><p>______School Official Signature Date ______School Athletic Department use only (if applicable): Suspension from participation dates: ______Suspension from competition date(s): ______</p><p>School Conference Date: ______</p><p>LCPS Form JKD-E1 (Rev. 8.13) (Previously 336-29) Distribution: Parent/Guardian, School, Title IV (if applicable) Suspension Offense Incident Codes and Description</p><p>Code Description Code Description</p><p>110 Disorderly Conduct/Disturbing 520 Breaking /Entering/Larceny Class 530 Criminal Damage of Property 120 Excessive Absences 540 Graffiti 140 Misbehavior for the Substitute 550 Missing Property/Theft 150 Unprepared or Refusing to Work 599 Other Vandalism in Class 610 Assault Simple (Verbal Threat) 160 Skipping Class or Detention 615 Assault with Hands, Feet, or 170 Tardy Fists 180 Truancy 620 Assault, Aggravated with 210 Bullying Firearm 220 Horseplay 625 Assault, Aggravated with Knife 230 Inappropriate Physical Contact or Cutting Object 240 Physical Confrontation (Bullying) 630 Assault, Aggravated with Other 250 Public Display of Affection Dangerous Weapon (PDA) 640 Assault/Battery, Simple 260 Running, Throwing, Wandering (Fighting) Hall 650 Assault/Battery with Hands, 270 Sexual Harassment/Sexual Feet, or Fists Misconduct 655 Assault/Battery with Knife or 310 Alcohol Possession Cutting Object 311 Alcohol Use 660 Assault/Battery with Other 320 Drug Possession, NOT Dangerous Weapon Marijuana 670 Battery, Sexual 321 Drug Use, NOT Marijuana 673 Motor Vehicle Theft 322 Drug Possession, NOT 674 Robbery Using Force Marijuana, Dealing 699 Other Violent Crime 330 Marijuana Use 710 Club or Striking Object 331 Marijuana Possession 720 Explosive Device 332 Marijuana Possession, Dealing 730 Handgun 340 Solvent Use 740 Knife or Cutting Object 341 Solvent Possession 750 Pocket Knife, Less Than 2.5 342 Solvent Possession, Dealing Inches in Length 350 Tobacco Use 760 Rifle/Shotgun 351 Tobacco Possession 770 Other Weapon, Non-projectile 410 Bomb Threat 780 Other Weapon, Projectile 420 Creating an Unsafe Situation 910 Assembly, Unlawful 430 Failure to Identify Oneself 911 Assembly, Disrupting a Lawful 450 Fireworks Possession 920 Computer Use Policy Violation 451 Fireworks Use 930 Forgery, Cheating, being 460 Leaving Campus without a Untruthful Pass/Permission 940 Inappropriate Dress 470 Pulling a Fire Alarm 950 Insubordinate, Refusing to do as 480 Rumors/Gossip Leading to Told Confrontation 960 Littering 490 Traffic or Vehicle Code Offense 980 Theft 495 Verbal Confrontation 999 Other, Please CHECK other 510 Arson codes. NOT a catchall.</p><p>LCPS Form JKD-E1 Page 2 of 2 (Rev. 11.06) (Previously 336-29) Distribution: Parent/Guardian, School</p>