In-School Suspension Form

Student: Grade:
Teacher: Class:
Administrator: Date:
Start Date: End Date:

Reason:

Schedule:  Arrive on time at _________________ every day

 Report to ___________________ in the library immediately

 Work only on school-related assignments

 Work quietly and without contact with other students

 Eat lunch in the detention room

 Sign out at the end of the school day with ____________________

Notes:

Student Signature: Date:

Parent Signature: Date:

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