Saint Philip School Middle School
Student Discipline Report
Name
_______________________________ Class________________.
Teacher___________________ Date________________.
Level One: Silent Lunch on the day following the infraction. Parent will be
called after third infraction. (A new accumulation of infractions will start
with each marking period.)
______1. Disruptive Behavior
______2. Missing Homework
______3. Chewing Gum
______4. Lateness/Loitering in Hallways or Restrooms
______5. Disrespectful Behavior/Attitude
______6. Peer Ridicule
______7. Repeated Violation of the dress code
______8. Failure to return signed parent forms/tests/etc.
______9.
Other___________________________________________________
_
Level Two: Morning Detention with written notice to parents, exclusion
from class parties, extra-curricula activities, field trips for five school
days. (A new accumulation of infractions will start with each marking
period.)
______1. Five Level One infractions within a marking period
______2. Improper Language/Gestures
______3. Intentional Pushing/Shoving
______4. Forging a Signature
______5. Verbal / Physical / Psychological abuse
______6. Cheating
______7. Insubordination
______8.
Other___________________________________________________
_
Level Three: One day in-school suspension, notification from principal,
exclusion from extra-curricula activities, parties, and field trips for one
month. The student is ineligible for the Honor Roll for the marking
period. A second suspension during the school year may result in
dismissal from school with reinstatement requiring the parents or legal
guardians obtaining approval from the pastor, principal and the
homeroom teacher in advance of returning.
______1. Three Level Two Infractions
______2. Fighting / Physical Aggression
______3. Vandalism
______4. Stealing
______5. Leaving School Grounds Without Permission
______6.
Other___________________________________________________
Level Four: Immediate Suspension pending a meeting with the
administrative team. For substance abuse and weapons policy
violations, action will be taken in accordance with diocesan guidelines.
______1. Truancy / Skipping School
______2. Possession of drugs, alcohol, cigarettes, tobacco
______3. Violation of weapons policy
______4.
Other___________________________________________________
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Teacher Signature
_____________________________________________
Parent Signature
_____________________________________
Student Signature
