Discipline Contract Classroom Removal: JKBA-E

The following contract has been developed in accordance with Policy JKBA Classroom

Removal of Disruptive Students by a Teacher

Student Name:___________________________________________________________________

Date:_______________________________

This contract is being (developed) (revised) after the (1st) (2nd) removal from class. (Attach any Classroom Removal Due Process Forms and previous discipline contracts.)

Statement of desired behavior goals:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student's action plan:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student consequences for failure to meet the goal:

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

In accordance with Policy JKBA Classroom Removal of Disruptive Students from the Classroom and C.R.S. 22-32-109.1 upon the third documented removal from the same class, the student will be removed from the class for the remainder of the term.

Student Signature:___________________________________________ Date:____________

Administrator Signature:______________________________________ Date: ____________

Teacher Signature:___________________________________________ Date ____________

Parent Signature:____________________________________________ Date_____________

 

SCHOOL DISTRICT 27J
CLASSROOM REMOVAL DUE PROCESS FORM

Student’s Name:_______________________________________________________

Date:____________________________

The following procedures were followed at____________ on __________, 20___.
This is the 1st / 2 nd / 3rd removal of this student from my class.

The student was informed of the conduct for which she/he was being removed from the classroom and gave the student an opportunity to explain his/her position on the matter. Teacher initials:

(Describe the student's statement.)

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

I have confirmed that the student does not have a disability under IDEA or §504. Teacher initials:___________

The student does have a disability under IDEA or §504 but I have confirmed that the removal does not constitute a change of placement. Teacher initials:___________

The parent(s) or legal guardian were contacted on ___________ at __________am/pm and a conference will be held on _________________at ______________am/pm.

If this is the 2nd removal, a discipline contract must be attached to this form.

 

 

Teacher signature:________________________________________________________________

Date:___________________

Administrator Signature:_________________________________________________________________

Date:____________________