Request for Expulsion Hearing

Request for Expulsion Hearing
Name of Schol
Date*

MonthDayYear
Date
Admin Name*

First NameLast Name
Admin E-mail*
example@example.com
Principal Email
example@example.com
Student Name*

First NameLast Name
Grade
Infraction/Readon Code as identified in JPAMS*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number*
Please enter a valid phone number.
Check All that Apply:

Student Recieves Special Education ServicesStudent has been classified 504Student has been referred to SBLC
Bring the following to the hearing:

JPAMS Court Report

Documentary evidence for the Infraction violoated

Include the following if applicable:

Behavior Plan

Functional Behavior Assessment
Select Supervisor

Elementary/Secondary - Jennifer Winslett
The hearing date has been set for Date at Time
Should be Empty: