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PRECIPITATING INCIDENT SUMMARY REPORT

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Student Name

Student ID

Student DOB

John Doe

123456

04/04/2003

Infraction Details:
Date: 2/5/15

Time: 09:00

Infraction: Assault/Student

Location of Incident: Quad

VICTIM(s):
WITNESS(es):
SUMMARY:

Jane Smith grade 6 #1234567

Dean McDean, Dean of Students
John Doe, Student (123456)

Summary on Thursday, February 5, 2015 a student Jane Smith [Grade 6 #1234567] hit John Doe [Grade
6 #123456] with a shirt stating it was because John Doe [Grade 6 #123456] was up in her face. Then
John Doe [Grade 6 #123456] pulled a wrench out of his backpack and held it up and threatened to hit
Jane Smith [Grade 6 #1234567] with the wrench. CCSD police Officer Bob spoke with Sally Smith, mother
of Jane Smith [Grade 6 #1234567] and informed her of the situation. Mrs. Smith told Officer Bob she did
not wish to press charges. Officer Bob spoke with Senior Doe and informed him of the incident involving
his son John Doe [Grade 6 #123456] . Officer Bob booked the wrench into evidence. A police report DR
number 10000000 0.1 was filed by Officer Bob. John Doe [Grade 6 #123456] was placed on a required
parent conference
John Doe [Grade 6 #123456] is a six grade student at Swainston Middle School. This is the fourth
discipline event for John Doe [Grade 6 #123456] this year. He has been referred to the office three times
prior this incident- once for classroom disruption, once for hitting another student, and once for
unacceptable school behavior, all resulting in required parent conferences. He is currently on suspension
for the current incident (Assault/Student).
A conference was held on Monday, February 9, 2015 with father Mr. Senior Doe and Dean McDean, Dean
of Students. Mr. Dean informed Mr. Senior Doe that the administration was recommending expulsion for
of the possession of a weapon and the threat made towards a student. The levels of due process were
explained to Mr. Senior Doe. Mr. Senior Doe disagreed and requested an appeal conference with Mr.
Green Brown, Assistant Principal.
An appeal conference was held with Mr. Brown on February 11, 2015. The levels of due process were
again explained to Mr. Senior Doe. Mr. Senior Doe signed the due process recommendation, agreeing
with the expulsion recommendation of homework request was submitted for John Doe [Grade 6
#123456] .
The administration of Swainston Middle School has determined that John Doe's [Grade 6 #123456]
behavior is contrary to the policies and regulations governing the students of the Clark County School
District and Swainston Middle School. Accordingly, the administration of Swainston Middle School is
recommending that John Doe [Grade 6 #123456] be expelled for violation of regulation 5141.1,
specifically item 1 weapons and threat to a student regulation specifically.

Prepared By: ________________________________________ Title: ___________________________

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Signature: __________________________________________ Date: ___________________________

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PRECIPITATING INCIDENT SUMMARY REPORT (Continued)

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SUMMARY (Continued):

Signature: __________________________________________ Date: ___________________________