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Safe School Violation Disclosure
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Safe School Violation Disclosure
Safe School Violation Disclosure
Andrew Smith
2020-09-29T11:55:04-06:00
Form for disclosing safe school violations during the registration process.
Student Name
*
First
Last
Grade
*
For what grade is the student seeking enrollment?
Please Select
K
1
2
3
4
5
6
7
8
9
Student birthdate
*
Date Format: MM slash DD slash YYYY
Violation Information
*
List all incidents separately. Use the + at the end of the row to add another row if needed.
Violation (choose from the dropdown menu)
Date (month/year)
Disciplinary Action Taken (or pending)
Location (school)
Name of Administrator
Fighting, gang activity, harassment
Destruction or defacing of school property
Behavior which poses a threat to the safety of others
Alcohol, tobacco, weapons, drug, illegal or controlled substance related
Criminal activity
Other
Name, position, and contact information of school official handling the violation(s), if known.
Details, comments, or explanation for any violations listed above.
If you have any documents to support the information, please upload them here, or give them to an OPA Principal.
Parent or Guardian Name
*
First
Last
Parent or Guardian phone number
*
Parent or Guardian email
Required if you would like to receive a copy of this form.
Parent or Guardian Signature
*
By signing, you are affirming that the information contained herein is accurate to the best of your knowledge.
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