School-Based Stay Away Agreement Sample Clauses

School-Based Stay Away Agreement. The intent of this agreement is to increase safety for students who have been the target of severe or repeated discrimination, harassment, and retaliation. It is to be administered by the principal or designee in a conference with the offending student and his or her parent. Name of student (print): Date of most serious incident: Description of behaviors involved in incident: Date of assessment by principal or designee: Date of parent notification: In order to protect the rights and safety of all members of our school community, you are re- quired to stay away from (insert name of targeted student) at all times during the school day and at any school-sponsored event. This means that you may not approach, talk to, sit by, or have any contact with (insert name of targeted student) at school or on school property, school buses, and bus stops. In addition, the following actions are effective immediately (list schedule changes), other dis- ciplinary and or restitution-related actions. Current Schedule New Schedule Other disciplinary actions: Violations of this agreement and acts of retaliation directly or indirectly toward the target or the target’s friends or family members will be taken seriously and will result in further discipli- nary actions. Your compliance will be monitored by (insert name and title of school staff). Agreement is valid from (date) to (date). This agreement will be reviewed on (date). Signatures: Student: Date: Parent/Guardian: Date: Administrator: Date: cc: Principal Assistant Principal Counselor SRO

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Related Clauses

Related to School-Based Stay Away Agreement