Short-Term Suspension Form[1]

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Prince George’s County Public Schools
14201 School Lane ▪ Upper Marlboro, Maryland 20772 ▪ www.pgcps.org

Notification of Student’s Suspension 
(Short­Term) 
 

FRIENDLY HIGH SCHOOL
TO: ______________________________________________________
_______________________________________
Parent or Guardian 
 
 
 
 
 
 
School 
_______________________________________________________________________________ 
 
_____________________________________________________ 
 
 
 
Address   
 
 
 
 
 
 
 
Date 
_______________________________________________________________________________ 
 
Special Education:     Yes________ No __________ 
 
 
 
 
 
 
 
 
 
 
Section 504: 
        Yes________ No __________ 
__________________________________         ________________________________________ 
 
Cumulative Days of Suspension 
 
     Home Phone   
 
        Work/Cell Phone 
 
 
 for Current School Year: ____________ 
 
RE: __________________________________________ 
  ______________________ 
 
_______________________________ 
____________ 
 
 
Student’s Name   
                       Student Number 
  
       Birth Date   
                    Grade 
 
This is to confirm the suspension of your child as of (Date) __________________________ for _________ days. The Code of Student Conduct 
violation(s) for this suspension (is)/ (are) as follows: 
____________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________ 
 
Guidance/Administrative/Disciplinary Procedures utilized prior to this suspension: 
 
GUIDANCE PROCEDURES 
 
ADMINISTRATIVE PROCEDURES 
     DISCIPLINARY PROCEDURES 
□ Teacher‐Student Conference   
□ Administrator‐Student Conference           □ Detention Hall 
     □ Behavioral Probation 
□ Teacher‐Parent Conference/Contact  □ Administrator‐Parent Conference 
     □ Temporary Removal from Class 
□ Teacher‐Counselor Conference 
□ Student Program Adjustment        
□ Teacher‐Administrator Conference  □ Referral to Student Services   
     □ Previous Suspensions 
□ Counselor‐Student Conference  
□ Referral to Psychological Services 
     □ ISSC (In‐School Suspension Center) 
□ Counselor‐Parent Conference  
□ Student Services‐Student/Parent Contact 
□ Functional Behavior Assessment/Behavior Intervention Plan (FBA/BIP) 
 
Other:____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________ 

 
To be checked if it applies: 
□ The above alternatives have been considered in this instance and are reasonably held inappropriate to resolving the problem. 
□ Parent/Guardian was provided a copy of the Procedural Safeguards. (For students with an IEP or 504 Plan.) 
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 
 
We are making an appointment for you to come to school at (Time) ______________ on (Date) _________________________. If you 
cannot  come  at  the  time  indicated  above,  please  call  (Principal/Designee)  _________________________________  at                 
(Phone No.) _________________________________ to arrange for another appointment. If we do not hear from you we will expect you at 
the time indicated above. Per the Code of Student Conduct, schools  are  required to provide make‐up work for students during 
the determined period of suspension. Please contact your child’s Counselor to request make‐up work.  
 
Following  the  conference  concerning  this  suspension,  if  you  wish  a  review  of  the  decision(s)  which  resulted  from  the 
conference, you may do so by writing to the Pupil Personnel Worker assigned to your child’s school within ten (10) days. 
 
___________________________________________________________ 
 
 
CC: _________________________________________________________ 
 
 
Principal’s Signature 
 
 
 
 
 
 
Pupil Personnel Worker 
 
Filing Instructions: 
- Forward a copy of this form to the Pupil Personnel Worker at the time of the suspension. 
- Discipline Records must be maintained until the student graduates or completes his/her educational program. 
□ Copy: To be Sent to Parent via Mail
□ Copy: To be Sent to PPW
□ Copy: School Administrator
PS-31 (08/10)

□ Copy: To be Given to Student for Transmittal to Parent
□ Copy: Cumulative Folder

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