Written Charge & Request for Expulsion

In order to receive a copy of your responses, you MUST check 'send me a copy of my responses' at the bottom of this form.

ENTY*

Select or enter value

SCHOOL OFFICIAL*

Select or enter value

GR*

2

3

4

5

6

7

8

9

10

11

12

AGE*

Select

SEX*

Select or enter value

RACE*

Select or enter value

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

Select or enter value

SPED*

Select or enter value

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:

Select

SUSPENSION DATE*

# DAYS of Suspension*

On the above date, this student was suspended for:

Select or enter value

HEARING RESULT

Select or enter value

DETERMINATION

Select or enter value

ATE

STUDENT ID

Created By

Select or enter value

Send me a copy of my responses

Privacy Notice|Report Abuse