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BOSWELL

PUBLIC SCHOOL PUBLIC SCHOOL

Administration
Discipline Form

Discipline Form

Discipline Form - Initial

Please Email yourself a copy of this form submission for your records.

Please Fill Out The Discipline Form Below

Referring Staff
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Date
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Time
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Student's First Name
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Student's Last Name
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Grade Level
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Location of incident:

Auditorium

Bathroom

Bus

Bus Loading Zone

Cafeteria

Classroom

Commons

Gym/Locker Room

Hallway

Library/Media Center

Office

Parking Lot

Playground

Special Event/Field Trip

Stairs

Inappropriate Behavior

Bullying

Cheating

Defiance

Disrespect

Disruption of class/school

Dress code violation

Inappropriate language

Lying

Physical contact

Skip class/truancy

Tardy

Teasing

Disciplinary Action

Change seating

Conference with Parent

Detention

Loss of privilege

Parent contact

Time in office

Other

Other

If other please specify

If Detention was assigned, enter the date and time.

Date
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Time
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If the Parent was contacted, enter the date, time, and method of contact.

Date
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Time
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Method of Contact

Email

Home visit

Letter (mail)

Letter (via student)

Phone call

Enter any comments here.

Email a copy to

optional

Required Fields

Contact Information

604 7th St., Boswell, OK 74727 • (580)566-2735 • Fax (580)566-2265

The Mission of Boswell Public Schools is to ensure that all Students are provided the educational opportunity to acquire the necessary knowledge and skills to be competent productive members of a global society.

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