Newark Unified School District 5715 Musick Avenue, Newark, CA 94560 Notification of Administrative Suspension from School School: Parent/Guardian Phone Number:

Date: Student’s Last Name: Suspension: From: Suspension: Return:                   

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created for the purpose of having one or more of the effects listed in (r)(1) (2)(A)(ii)(II) Creating a credible impersonation having one or more of the effects listed in (r)(1) (2)(A)(ii)(III) Creating a false profile for the purpose of having one or more of the effects listed in (r)(1)

 (t) A pupil who aids or abets in the attempted or infliction of physical injury to another.  .2 Committed sexual harassment. (Grades 4-12).  .3 Attempted, threatened, caused, or participated in hate violence.  .4 Created an intimidating or hostile educational environment. (Grades 4-12).

 .7 Made terroristic threats against school officials or property. ++ Indicates law enforcement MUST be notified

Birthdate

Foster Youth 504 Plan Special Ed Student Yes No Yes No SDC RSP Spch/Other Police Report N/A Expulsion Review N/A File # Called Student Services:

Education Code Section 48900 (a)(1) Caused, attempted to cause, or threatened to cause physical Injury. (a)(2) Willfully used force or violence on another person, except in selfDefense.++ (b) Possessed, sold or otherwise furnished any firearm, knife, explosive or other dangerous object.++ (c) Possessed, used, sold, furnished, or been under the influence or any controlled substance, alcohol, or intoxicant.++ (d) Offered, arranged, or negotiated to sell a controlled substance, alcohol or intoxicant and then provided a replica substance.++ (e) Attempted or committed robbery or extortion. (f) Attempted or caused damage to school or private property. (g) Attempted or stole school or private property. (h) Possessed, or used a tobacco product. (i) Committed an obscene act or engaged in habitual profanity or vulgarity. (j) Possessed, offered, arranged or negotiated to sell drug paraphernalia. (k) Disrupted school activities or defied school personnel (No suspension grades K-3) (Cannot be only violation for expulsion case). (l) Knowingly received stolen school or private property. (m) Possessed an imitation firearm. (n) Attempted or committed sexual assault or committed a sexual battery++ (o) Harassed, threatened or intimidated a complaining witness or a witness in a school disciplinary matter. (p) Unlawfully offered, arranged to sell, negotiated to sell, or sold the prescription drug Soma (q) Engaged in, or attempted to engage in, hazing. (r) Bullying. One or more acts, either personally or electronically, as defined in Ed Code  48900.2, 48900.3,  48900.4, placing and/or causing reasonable pupil(s) to:  (1)(A) Fear of harm to person or property.  (1)(B) Substantial detrimental effect on physical or mental health.  (1)(C) Substantial interference with academic performance.  (1)(D) Substantial interference with ability to participate in or benefit from school  (2)(A)(i) A message, text, sound or image  (2)(A)(ii) A post on a social network web site including but not limited to:  (2)(A)(ii)(I) Posting or creating a burn page. “Burn page” means an Internet Web site 

Student ID

MANDATORY RECOMMENDATION FOR EXPULSION for act committed at school OR at school sponsored activity (ED CODE §48915(c):  (1) Sale, possession or furnishing a firearm++  (2) Brandishing a knife at another person++  (3) Selling a controlled substance++  (4) Sexual assault or sexual battery++  (5) Possession of an explosive++ QUASI-MANDATORY RECOMMENDATION FOR EXPULSION for act committed at school OR at school sponsored activity (ED CODE 48915(a)(1):  (A) Causing serious injury to another person, except in self-defense++  (B) Possession of a knife, or other dangerous object of no reasonable use to the pupil++  (C) Unlawful possession of any controlled substance except for the (i) first offense for the possession of not more than one avoirdupois ounce of marijuana, other than concentrated cannabis, or (ii) OTC or prescription medication prescribed by a physician for own use++  (D) Robbery or extortion  (E) Assault or battery on any school employee++

Parent/Guardian Informed or Conference Held Requested Via Phone Date: Time: Contact Name:

By:

. Student Conference:  Held on OR Date:

 Postponed until:

Time:

Total Days Suspended in the School Year Including THIS Suspension:

Note: All allegations of BULLYING must be logged, investigated and kept in file on site. Scan and email outcomes to Student Services NUSD57 (3/2016) (sk) Suspension Form Page 1 of 2

Notification of Administrative Suspension from School (Continued) Student Name: Factual explanation of incident(s): Date: Location:  On Campus  Off Campus

Date: Time: During Class/Period:  School activity off school grounds  Attendance Related

Location Description:

Dear Parent(s)/Guardian(s): This suspension is in compliance with Education Code Section 48900 and 48910/48911 et seq. The suspension has been discussed with your student and he/she has been given an opportunity to explain his/her side of the incident.* If a conference has been requested, please make every effort to attend. Under state law, you are required to respond to this request without delay. If you wish, you and your student may review his/her record as provided in Education Code 49069. Make-up work and/or tests may be provided for your student, if requested, for the period of suspension. If you feel the suspension is inappropriate and have discussed your concerns with the school principal, you may appeal the suspension to the Coordinator of Student Services. Call the Student Services Department, (510) 818-4202 for an appointment. PLEASE NOTE: During the school day, your student must not be on or near any school campus. Supervision is the responsibility of the parent/guardian during the suspension. By:

Principal/Designee *The principal or designee may suspend a student without a conference if an emergency situation exists. State laws allow the principal to recommend expulsion for violations of Education Code section 48900 subdivisions (a), (b), (c), (d), (e), and other subdivisions upon a first offense, if the pupil’s presence is deemed to be a danger.

NUSD57 (3/2016) (sk) Suspension Form Page 2 of 2