Master Agreement 2005 - State Employment Relations Board

Removal of Student Form
REMOVAL
Columbus Public Schools
REMOVAL FROM A CURRICULAR OR AN EXTRACURRICULAR ACTIVITY
The presence of the student indicated below poses a continuing danger to persons or property or an ongo·
ing threat of disrupting the academic process.
Student Name
Class/Extracurricular Activity
Date lime
As soon as practicable, I will submit the reasons for such removal and additional required documentation.
REASONS FOR REMOVAL
Teacher's Signature
(This portion of the form must be completed and submitted to the principal or his/her des~nee as soon as
practicable.)
I removed this student from my dasslsupervised extracurricular activity because:
Attach all documentation that demonstrates your pr~r atte~ts to correct the students behavior. Th~ dorulre!ltalion
must include, but is not limited to, classroom behavioral m if~ation plans, parental conlerencesl~hone callslliritten
commun~tions , and copies of the Corrective Measure Commun~t10n Fonms (School Fonm 190 .
Date lime Teachers Signature
HEARING
(This section Is to be ccmpleted by the building principal or his/her de~gnee . A hearing must be held within
three (3) school days from the time the inaial removal is ordered. The teacher is required to anend the hear·
ing.)
Hearing Date lime
Check one: _Student will not be reinstated until after the hearing.
_Student will be reinstated prior to the hearing (The teacher may request in writing reasons for this rein·
statement)
Date Principal or Designee's Signature
Submn copy at lime of removal. Send an additional copy to the principal for routing after you have completed the Rea·
sons for Removal section and attached supporting documentation. Keep a copy ror your files.
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