Written Charge & Request for Expulsion

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ENTY *

SCHOOL OFFICIAL *

GR *

2

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5

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7

8

9

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AGE *

SEX *

RACE *

STUDENT LAST *

STUDENT FIRST *

MISCONDUCT *

Brief description of infraction/misconduct:

P/G LAST *

P/G FIRST *

STREET *

CITY *

ZIP *

CELL # *

Format: 317-123-4567

HOME #

ESL

SPED *

TOR (Last, First)

(if applicable)

MANIFEST DATE

TERM of EXPULSION *

This misconduct constitutes a violation of validly adopted student conduct rules(s) and/or Indiana Code 20-33-8-14/20-33-8-15. In my opinion, this misconduct requires that this student be expelled from the MSDLT schools until:

SUSPENSION DATE *

# DAYS of Suspension *

On the above date, this student was suspended for:

HEARING RESULT

DETERMINATION

ATE

STUDENT ID

Created By

Type to search

*

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