PRECIPITATING INCIDENT SUMMARY REPORT

Student Name

John Doe

1
Page 1 of _______

Student ID

Student DOB

123456

10/16/01

Infraction Details:
Date: 2/3/15

Time: 09:00

Location of Incident: classroom

Infraction: Threat

to Staff

#309

VICTIM(s):
WITNESS(es):

Suzy Smith, teacher

SUMMARY:
On Tuesday, February 3, 2015, John Doe, a seventh [7] grade student attending Swainston Middle School
threatened the teacher and his classmates, stating that he would "bring a mellee gun to school and shoot them all
dead" during class instruction, disrupting the class at Swainston Middle School. John Doe [Grade 8 #123456]
refused to follow Ms. Smith's instructions. He threatened students with physical harm, stating "I'm going to slap
your braids right off your head" in front of the class. John Doe [Grade 8 #123456] intimidated and threatened
classmates. John Doe [Grade 8 #123456] was placed on RPC-T on Tuesday, February 3, 2015 and his mother,
Linda Doe, was notified regarding the RPC.
Over the past year, John Doe [Grade 8 #123456] has been seen forty-one [41] times in the Deans Office. These
incidences include: tardies [6]; unacceptable school behavior [8]; class disruption [12]; dress code [5]; bus
infraction [1]; disregard rules and regulations [1]; insubordinate [2]; threat to student [2]; verbal confrontation [2];
aggressive behavior [1] and threat to staff [1] . Interventions have included: detentions, conferences, in-house
suspensions and formal suspension. Despite the interventions employed by Swainston Middle School, John Doe
[Grade 8 #123456] disregard of the school rules and regulations has escalated.
A Required Parent Conference was held on Friday, February 6, 2015 with John Doe [Grade 8 #123456]; John
Doe's [Grade 8 #123456] mother, Linda Doe; John Doe's [Grade 8 #123456] grandfather, Jack Doe; Lucy
Teacher, teacher; Sally Sallyson, principal; Kim Kimson, from Student Threat Evaluation and Crisis Response and
Dean McDean, Dean of Students. At the conference, Mrs. McDean informed John Doe's [Grade 8 #123456]
mother, Linda Doe, that the administration of Swainston Middle School was recommending expulsion due to John
Doe's [Grade 8 #123456] threat to staff, Suzy Smith, his teacher, and his continued disregard of school rules and
regulations.
The levels of due process were explained to Linda Doe, John Doe's [Grade 8 #123456] mother, by Dean McDean,
Dean of Students Swainston Middle School on Friday, February 6, 2015. John Doe's [Grade 8 #123456] mother,
Linda Doe, AGREED with the recommendation and signed the due process document accordingly. A homework
request was made and John Doe's [Grade 8 #123456] mother, Linda Doe was informed of the procedures for
retrieving the homework while John Doe [Grade 8 #123456] was suspended pending expulsion.
The administration of Swainston Middle School has determined that John Doe's [Grade 8 #123456] behavior is
contradictory 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 8 #123456] D.O.B. 10-16-2001, be referred for expulsion from the Clark County School District for
violation of CCSD Regulation 5141.1, specifically item VII, and subsection V: B (Verbal Abuse, Intimidation, or
Cyber-Bullying) and E (Violations of Authority and Behavioral Guidelines).

Dean
Prepared By: ________________________________________ Title: ___________________________
Print Name

February 9, 2015
Signature: __________________________________________ Date: ___________________________