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Bus Discipline Referral

New Boston ISD

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Report of Bus Conduct

Complete the report and select the student's campus. The referral is delivered to that campus principal only.

Do not fill this out:

Referral NumberGenerating…

Send To Campus Principal

Select a campus. The referral goes only to the principal's office of the campus selected here.

Student

Class / Grade

Date

Date of Incident

Time of Incident

Bus No.

Driver

Notice to Parents: This is to advise you that the above named student was involved in a disciplinary matter, which could be unsafe. Please understand the driver's action and the corrective effort the district has made.

Driver's Report

Select each behavior that applies.

Destroying Property Bringing Injurious or Objectionable Things Aboard Bus Disobeying Driver Fighting, Tripping or Pushing Others Hanging Out of Window Throwing Things into or from Bus Lighting Matches or Smoking Spitting or Littering Unacceptable Language Damaging Bus Equipment Rude, Discourteous, Noisy or Annoying Improper Boarding or Departure Procedures Other Improper Behavior

Comments

Offense

First Offense Second Offense Third Offense

Action to Be Taken

Authorized Signature (Typed Name)

Title

Printable referral file

Paper equivalents: white — parent copy, canary — office copy, pink — driver copy. A print-ready copy of this referral is attached to the email the principal receives. Print a copy before submitting if a signed paper copy is required. Internet access is required when submitting.