Yellow Discipline Referral Form

Yellow Discipline Referral Form

* 1. Please fill out the following information:

Student:

Date:

Staff:

Time:

Location:

* 2. Please indicate the following:

	Check The Following
Dress Code Violations	Dress Code Violations Check The Following
Excessive Tardiness to Class	Excessive Tardiness to Class Check The Following
Disrespectful Behavior	Disrespectful Behavior Check The Following
Lying To Staff or Administrator	Lying To Staff or Administrator Check The Following
Profane or Obscene Behavior	Profane or Obscene Behavior Check The Following
Inappropriate Public Display of Affection	Inappropriate Public Display of Affection Check The Following
Unauthorized Entry or Exit from a Room or Building	Unauthorized Entry or Exit from a Room or Building Check The Following
Computer Misuse (including social media)	Computer Misuse (including social media) Check The Following
Malicious Gossip / Harassment	Malicious Gossip / Harassment Check The Following

Please provide additional details.