Written Charge & Request for Expulsion

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ENTY*

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SCHOOL OFFICIAL*

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STUDENT FIRST*

STUDENT LAST*

ESL

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TOR (Last, First)

(if applicable)

STUDENT ID*

RACE*

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SEX*

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AGE*

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GR*

2

3

4

5

6

7

8

9

10

11

12

SPED*

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REVIEW DATE*

MISCONDUCT*

Brief description of infraction/misconduct:

Supporting Documents

Upload an supporting documentation/information that will better inform/assist in the processing of this Request for Expulsion.

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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:

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Because he/she must accept the well-defined consequences of his/her actions, I request that you initiate expulsion proceedings.

SUSPENSION DATE*

# DAYS of Suspension*

On the above date, this student was suspended for:

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P/G FIRST*

P/G LAST*

STREET*

CITY*

ZIP*

CELL #*

Format: 317-123-4567

HOME #*

Format: 765-123-4567

REVIEW TIME

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