TSFC CITIZENSHIP CONCERN

Faculty - Staff Name

Student Name

Select a Date

Grade

Time - Location

Citizenship Concern

Consequences (optional):

Administration Communicates with Family

Early pick-up from School

Immediate Administration Referral

Parent/Guardian Conference Needed

Restoration/Restitution (Ms. Kathy)

Teacher Communicates with Family

Verbal Redirection

Verbal Warning

Refer to Threat Assessment Team

Natural Consequence [I.E: loss of recess, social lunch, centers]

Description (bullet points):

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