St. John-Endicott High School Behavior/Referral Form
Student:
Grade:
Date:
Class:
Referred by:
1.
Adherence to District Rules
9.
Failure to Attend Teacher Detention
17.
Theft &/or Property Damage
2.
Assault/Grievous
10.
Inappropriate Behavior/Sexual Misconduct
18.
Tobacco/Controlled Substance
3.
Bullying/Intimidation
11.
Inappropriate Display of Affection
19.
Truancy/Attendance
4.
Cheating/Copy/Disclosing Test
12.
Misrepresentation/Forgery
20.
Threats/Extortion/Coercion
5.
Closed Campus/Restricted Area
13.
Physical Aggression/Fighting
21.
Vandalism/Willful Misuse of Prop
6.
Disruptive Conduct
14.
Profanity
22.
Weapons/Guns/Dangerous Items
7.
Dress Code Violation
15.
Tardiness
23.
Willful Disobedience/Defiance of School Authority
8.
Drugs/Illegal Substance/Paraphernalia
16.
Technology Misuse
24.
Other
Time
Staff Action
Before School
Verbal Warning
Student Signature:
Lunchroom
Referral to Principal
Classroom
No Action Required By Principal
After School
Comments:
Action:
Parent/Guardian Contacted:
Time:
Principal's Signature:
.
Date: