| Applicant: |
|
____________________ |
| School: |
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____________________ |
| Officer: |
|
____________________ |
| |
|
|
| Truancy: |
|
____________________ |
| Vandalism: |
|
____________________ |
| Thefts: |
|
____________________ |
| Violent Acts: |
|
____________________ |
| Physically Assaulted Students: |
|
____________________ |
| Verbally Assaulted Students: |
|
____________________ |
| Physically Assaulted School Personnel: |
|
____________________ |
| Verbally Assaulted School Personnel: |
|
____________________ |
| Disruptive Classroom Behavior: |
|
____________________ |
| Fights Reported at School: |
|
____________________ |
| Tobacco Violations by Students: |
|
____________________ |
| Alcohol Violations by Students: |
|
____________________ |
| Weapon Violations by Students: |
|
____________________ |
| Students Arrested: |
|
____________________ |
| Students Referred to Diversion: |
|
____________________ |
| Students on Probation: |
|
____________________ |
| In-School Suspensions: |
|
____________________ |
| Out-of-School Expulsions: |
|
____________________ |
