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:
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.)
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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.
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