the mba experience: growing tomorrow’s leaders to
TRANSCRIPT
The MBA Experience: Growing tomorrow’s leaders to transform lives
and communities. 4443 S. Germantown Road -Memphis, TN 38125
Principal-Ms. Marsharee Shaw 901-505-0551 901-757-4532 (FAX)
[email protected] School Hours: Monday-Friday
7:00-4:00The MBA Experience: Growing tomorrow’s leaders to
transform lives and communities. 4443 S. Germantown Road -Memphis,
TN 38125
Principal-Ms. Marsharee Shaw 901-505-0551
a. Lease agreement in the parent/guardian name
b. Mortgage statement in the parent/guardian name
c. Parent/guardian driver’s license
d. MLGW or telephone bill
e. Any governmental or official court documents with parent/ guardian name and
address (WIC, Families First, child support, etc.)
• Most recent report card
• Certified copy of Birth Certificate
• Social Security card
• Current/valid Immunization record on TN School form (completed within the last 12
months and signed by a doctor/clinic
• Parent/Student/Principal introduction meeting when documentation is submitted.
2. Forms of Proof of Residence
a. Lease agreement in the parent/guardian name
b. Mortgage statement in the parent/guardian name
c. Parent/guardian driver’s license
d. MLGW or telephone bill
e. Any governmental or official court documents with parent/ guardian name and address
(WIC, Families First, child support, etc.)
Check One: Elementary _________________
Student?
Is this student currently under suspension/expulsion at another school?
Has this student been adjudicating (giving a ruling) delinquent for having committed a violent crime?
Has this student ever been previously enrolled in a Shelby County School?
If yes, please list the Tennessee School/SCS School Name, City, Year
Yes _____
No______
Yes _____
No______
Yes _____
No______
Yes _____
No______
DOB: Race Gender
Custody Alert? Yes( ) No( )
If yes, please attach an explanation including a COPY of any court orders
Medic Alert Does the student have any medica conditions? Yes( ) No( )
Is a language other than English spoken in the home?
Yes( ) No( )
Country of Origin Special Education Information Has student ever been enrolled in a Special Education?
(Circle One) Resource 504 Gifted Program
School Last Attended:
City State Zip
Parent Information 2:
City State Zip
Parent Contact
Inclement Weather
Dear Parents/Guardians,
In the event we have an abbreviated school day (due to inclement weather), you can remain informed by going to the
Memphis Business Academy website: https://memphisbusinessacademy.com/
In case school is dismissed early due to inclement weather, my child should use:
______________Usual transportation home (example: car rider or walker) Contact Person #1 Contact Person #2 Contact Person #3
Cell: Cell: Cell:
Relationship to the student: Relationship to the student: Relationship to the student:
I certify that information contained in this application is true and complete. I understand that false information may be grounds for my child to not be accepted into Memphis Business Academy and/or Memphis STEM Academy or dismissed at any point in the future if my child is accepted. I authorize the verification of any or all information listed above. Parent Signature Date
Emergency Contact Information & Inclement Weather
Other persons to call in case of emergency or illness: Only parents/guardians listed below may check out your child. Emergency contacts must be 18 or older and will be required to provide ID.
Student’s Name Grade DOB
Check all that Apply
Anemia Diabetes Leukemia Sinus Problems
Anxiety attack Depression Low Blood Pressure Stroke
Arhritis Dialysis Meningitis Vision Problems
Artifical joints Fractures Menstrual Cramps Vomiting
Artifical valves(heart) Glasses Migraine Headache Speech Problems
Asthma Headaches Nosebleeds
Broken bones Heart Problems Reflux Crutches/Walker
Cancer Hemophilia Rheumatic Fever Wheelchair
Contact lens High Blood Pressure Scoliosis OTHER
Concussion ) Hypoglycemia Seizures
Fish-Milk-Eggs)
Environmental (Trees— Grass-Dust-Dirt)
Insects (Bees- Wasps) Allergies If you have checked any of the aboved please provide specific
information Latex Smoke
Student’s Name Grade DOB
Medical
Medications- Name medications your child takes in additon for the Epi Pen to treat an allergic reaction
Home(Give name, dose, and time taken) School (Give name, does, and time taken)
Physicians
to appropriate school system staff.
Parent signature prohibits disclosure of health information to school staff.
Parent Signature: Parent Signature:
Does your child require health care procedures such as Catheterization—Tube Feeding Yes No
Does your child routinely take medicine at home or at school? Yes No
Does your child require an Epi Pen for an allergic reaction? Yes No
Does your child have severe allergies Yes No
My child has stopped breathing because of an allergic reaction. Yes No
Lunch Information
School Address 4443 S. Germantown Road
Memphis, TN 38125
Do not fill out this section. For school use only Student ID: Y N
Parent Name Street Address City, State, Zip
Students Name Social Security Upcoming Grade Levels Attending Schools Date of Birth Race Gender
Please check TWO boxes below:
Check One Household Size Check One Annual Gross Income Check One Annual Gross Income
1 Between $0-$21,590 Above $21,590
2 Between $0-$29,101 Above $29,101
3 Between $0-$36,612 Above 36,612
4 Between $0-$44,123 Above $ 44,123
5 Between $0-$51,634 Above $51,634
6 Between $0-$59,145 Above $59,145
7 Between $0-$66,656 Above $66,656
8 Between $0-$74,167 Above $74,167
I certify (promise) that all information on this application is true and that all income is reported. I understand that school will receive federal and state funding
based on the information provided. I understand that school officials may verify(check) the information.
Sign and Date:
TRANSFORM FORM
Student Name:
Student Enrollment and Records-also to be used for other select transfers
All applications received between March 26 through April 30 will be sorted by priority category (Sibling, Choice, etc.) and processed “first come, first served” within
priority category. All applications submitted after April 30 will be processed in order of receipt. Applications will be accepted between January-May.
Please select the appropriate legal residency of the Parent/Legal Guardian:
_ City of Memphis _ Non-City __Shelby County Resident*
_ Other TN County* _ State other than TN*
* All non-city residents, except SCS employees who reside within Tennessee, are required to pay tuition and to present receipt at registration.
Type of Transfer Requested
_x Open Enrollment _ Sp Ed Sibling _ Psych/Med _ Other : ____________________________
We must have current and accurate contact information. Any inaccurate information at the time of processing may result in the inability to process your request. If
any contact information changes, you must call the Office of Student Enrollment and Records at 416-5830.
For Sibling Transfer
Brother/sister must have been enrolled in the sibling’s requested school and must
be returning
_____MBAE Berclair _____MSA
Siblings Name Siblings Current School DOB Grade
For School and Office Use only
Student PIN Number: Previous PIN: Approved
By: Date:
Parent Signature & Date:
Tennessee Parent Occupational Survey-Page 1
In order to better serve your child, our school district wants to identify students who may qualify to receive additional educational services, such as tutoring,
school supplies, free or reduced-price lunch, summer camps, and other services. The information provided below will be kept confidential. Please answer the
following questions and return this form to your child’s school.
Today’s Date School Name:
Memphis Business Academy Hickory Hill
Parent/Guardian First & Last Name
Student First & Last Name Student Grade Level:
Have you or an immediate family member performed any of the jobs listed below temporarily or seasonally, in any part of the United States, in the past three
years?
( ) No ( ) Yes Check all that apply and list the total number of months worked.
Agriculture/Field Work (planting, picking, sorting
crops; soil preparation; irrigation; fumigation)
Processing & Packaging (fruit, vegetables, chicken, eggs, pork, beef)
Total Months Worked: Total Months Worked
Dairy/Cattle Raising (feeding, milking, rounding
up)
landscaping not included)
Total Months Worked Total Months Worked
Tennessee Parent Occupational Survey-Page 2
In order to better serve your child, our school district wants to identify students who may qualify to receive additional educational services, such as tutoring,
school supplies, free or reduced-price lunch, summer camps, and other services. The information provided below will be kept confidential. Please answer the
following questions and return this form to your child’s school.
Months Years Weeks
Best Day of the Week & Time of Day to Call
For School Use Only: Please send survey with two YES responses to your district migrant liaison. If you have questions, call (931) 212-9539 to speak with the
Tennessee Migrant Education Program
Primary Home Language Survey
Former Students Do not have to complete this form!
New Students This form must be completed by the parent or legal guardian during registration for ALL NEW MBA/MSA EXECUTIVES
Student Name:
most often outside of school?
What language do people usually speak most often outside of school? What language do people usually speak in the
child’s home?
Does your child have Refugee Status?
Yes No In what language do you want notices sent to you from the
school?
Was this child born in the United States? Yes NIf no, list the birth country:
This section is to be completed only for executives who answered any questions 1-3 with a language other than English. • Category C-Speaks English and the other language equally well. • Category D-Speaks mostly English • Category E-Speaks only English
LAU Category (check one) • Category A-Speaks only the language other than English • Category B-Speaks mostly the language other than English
Signature of Parent/Guardian Signature of Questioner
Month Day Year
____________ A paraprofessional’s qualifications.
____________An annual notice of Student Education Records, Privacy and notice for disclosure of School Directory Information.
____________Their child’s level of achievement of each of the state’s academic assessments.
____________Notification of right to transfer their child to another school in the district if the student becomes the victim of a violent crime or is assigned to an unsafe school.
____________District Family Involvement Policy and School Parent Involvement Policy.
____________Their right to public school choice, and more effective involvement if their child’s school is identified for school improvement.
Parent Signature Date
No Child Left Behind School Parent/Student Compact
Executive Parent/Guardian’s Agreement It is important that I take a
more responsible role in helping my Executive. Therefore, I shall
strive to do the following:
• Provide 20 volunteer hours per year to MBA/MSA ,10 per
semester
• See that my child is punctual, has necessary supplies, and
attends school regularly
• Support MBA in the its efforts to maintain proper discipline
• Establish a time and quiet well-lit place for homework and
review it regularly
• Encourage my child’s efforts and be available for questions
• Stay aware of what my child is learning and communicate
about the progress
• Review, sign, and return all paperwork from MBA
• Arrange for my child to take advantage of after school tutoring
• Make sure that my child wears proper uniform attire every day
• Develop a partnership with MBA to help my child achieve the
highest standards
• Attend schedule parent meetings, conferences, and workshops
MBA/MSA Executive Agreement It is important that I work to the
best of my ability. Therefore, I shall strive to do the following:
• Attend school regularly, arrive on time, and actively participate in
all classes
• Do my best to do quality work at all times
• Observe regular study hours
Executive conduct and follow classroom policies and procedures.
• Wear uniforms everyday
Parent Signature: Student Name:
• @ACCESS RELEASE AND AUTHORIZATION FORM
• As a condition of using the MBA/MSA network, I agree to comply with the E-mail and Internet Acceptable User Agreement
(“Agreement”). I have read, and I understand the Agreement. Should I commit any violation, my access privileges may be revoked, and
disciplinary action may be taken, including suspension/expulsion.
• @I UNDERSTAND THAT MY MBA NETWORK ACCOUNT IS NOT PRIVATE. I CONSENT TO MBA/MSA MONITORING ALL MY ACTIVITIES ON
THE NETWORK, INCLUDING E-MAIL, INTERNET ACTIVITY, AND ALL FILES AND DOCUMENTS STORED IN THE MBA NETWORK.
• @As a parent or legal guardian of the child who signed above, I grant permission for him/her to access networked computer services such
as e-mail and the internet. I understand that (s)he is expected to use good judge and follow rules and guidelines set forth in the
Acceptable Use Agreement (“Agreement”). MBA/MSA cannot be responsible for the child’s use of the MBA/MSA network, including any
ideas and concepts that (s)he may gain by his/her use of the Internet or for the actions that (s)he takes through the use of the Internet. I
release MBAE/MSA, the school, their officers, agents, and employees, from all costs, claims, and liability resulting from the use of the
MBA/MSA network by the child.
• I have read the Agreement and accept the rules and conditions in the Agreement. I release MBAE/MSA, the school, their officers,
employees, and agents from any claim arising out of the child’s use of the MBA/MSA network. I agree to indemnify and to hold harmless
MBAE/MSA, the school, their officers, employees, and agents from any costs, liability, or claims arising from the child’s use of the
MBA/MSA network.
Student Name:
• @To protect the privacy of your Executive while enrolled at Memphis Business Academy/Memphis STEM Academy, there is a policy
governing the confidentiality of child information. As part of the policy, we will not allow your child to be videotaped or
photographed by anyone who is not a SCS Board, MBA/MSA Approved Organization, and/or Staff member of MBA/MSA, without
your permission.
• @The purpose of this form is to provide you with the opportunity to deny permission for your child to be videotaped or
photographed as a normal part of school activities from outside groups, such as the newspaper, media, or special programs within
the district.
• @If you agree, your child may participate in programs or other activities that could be videotaped or photographed for publicity or
news stories. Your child may appear in or on the following media: brochures, videos, newsletter, radio talk shows, newspaper
articles or television news, which may be used to promote MBA/MSA or the school district.
• @I understand that any media and video opportunities will be in line with the mission and educational philosophy of MBA/MSA and
SCS.
Check One
____Yes, my Child may participate. ___No, my Child may not participate
Parent Signature & Date
CODE OF CONDUCT
Parent Consent for Corporal Punishment
In addition to the MBA/MSA Code of Conduct that is available in the MBA/MSA Handbook, I am aware that MBA has instituted a
Corporal Punishment as a form of discipline with parent consent.
Check One
_____________ I agree that my child will receive corporal punishment for discipline infractions.
_____________ I do not agree that my child will receive corporal punishment for discipline infractions.
Comments:
Student Name: Parent Signature & Date
Attendance The Tennessee State Compulsory Attendance Law (T.C.A.§49-6-3001 and T.C.A. §49-6-2007) requires that pupils of legal age attend school (ages of six and seventeen years, both
inclusive) unless special circumstances arise which temporarily or permanently excuse the student from attendance. This also applies to five (5) year old students who have attended school for six
(6) weeks. By state law, the student’s school year shall consist of a minimum of 180 teaching days exclusive of all vacations, as approved by the board of education. (T.C.A.§49-6-3004) The annual
calendar is divided into two semesters. A copy of this calendar is included at the front of this handbook.
Enrollment of Students Beyond Compulsory Attendance Age (Policy #6010) During the first twenty (20) days, students beyond compulsory attendance age [eighteen (18) years of age or older]
who have been continuously enrolled with the district may register for school through the standard registration process. However, upon enrollment, all such students shall meet with their school
principals and other appropriate staff to evaluate academic options and make appropriate education placement referrals for the students, including overage for grade students; and outline the
academic and behavioral expectations of the student within the school. SCS Student Handbook 12 2019-2020 An application for admission must be evaluated for approval by the principal for a
person eighteen (18) years of age or older who:
1. has dropped out of school and wants to re-enter; or
2. 2. fails to enroll within twenty (20) school days after school officially starts, unless one or more of the following applies:
A. The student can show proof of satisfactory attendance in another school system during the first twenty (20) day period.
B. A doctor's certificate states that illness has prevented enrollment during the first twenty (20) day period.
C. The district is required to permit the student to enroll under the Individuals with Disabilities Education Act.
Students not initially accepted for enrollment by the principal may then contact the district department responsible for student services for possible enrollment.
Attendance of Students Beyond Compulsory Attendance Age (Policy # 6011) Any student having passed the compulsory attendance age may be dropped from the rolls after three (3) consecutive
unexcused absences, or an aggregate five (5) unexcused absences, from class or school, upon approval of the superintendent (or designee).
Compulsory Attendance (Policy# 6012) Students between the ages of six (6) and seventeen (17), both inclusive, must attend a public or non-public school. The principal shall be responsible for
the initial placement of students entering school for the first time. A parent/guardian or legal custodian who believes that their child is not ready to attend school at the designated age of
mandatory attendance may make application to the superintendent (or designee) for a one (1) semester or one year deferral in required attendance. Any such deferral shall be communicated to
the principal of the school that the student would have attended. In accordance with the provisions outlined in the state law, the Board may temporarily excuse students from complying with the
provisions of the compulsory attendance law.
Truancy (Policy #6016) Unauthorized absence from school is considered truancy and will be treated as such. This includes absence from any class, study hall, or activity during the school day for
which the student is scheduled and remedial programs that are offered at no cost to parents provided that prior to requiring the student to attend the program a commitment of transportation is
provided to those students who qualify for transportation to and from school. The principals, in coordination with any teachers who provide instruction to a student and any other appropriate
school faculty, shall make the decision to require the student's attendance at such remedial instruction SCS Student Handbook 14 2019-2020 occurring outside of the regular school day, including
but not limited to programs conducted during the summer and after the conclusion of the regular school day pursuant to state law.
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities
ATTENDANCE, ABSENCES, TRUANCY, AND WITHDRAWAL POLICY-PAGE 2
Make-up Work-In the event of an excused absence, students are expected to make up work missed within a reasonable time. In the event of an unexcused absence, one day of makeup time shall
be allowed for each day of unexcused absence, if the following conditions are met. The parent of a student or a student with an unexcused absence must submit a written request to the teacher
to makeup the work and must participate in an appropriate intervention (e.g., student or parent conference with the teacher, Saturday school, online tutorial, other appropriate intervention
determined and scheduled by the teacher). For absences due to long-term suspension (over 10 days)/expulsion, the program of making up work shall be in accordance with state law
Attendance and Excuses (Policy #6014) The Shelby County Board of Education believes that regular attendance is a necessary requirement of all students. All students are expected to attend
school on each day that school is officially in session and remain at school for the entirety of the school day. Only the following reasons will be considered for excused absences:
1. Illness, injury, pregnancy, homebound circumstance, or hospitalization of student. The District may require a parent conference and/or physician verification to justify absences after the
accumulation of ten (10) days of absence during a school year. Notes must be date specific and will be required for subsequent absences beyond ten (10) days.
2. Death or serious illness within the student's immediate family.
3. When the student is officially representing the school in a school sponsored activity or attendance at school-endorsed activities and verified college visits.
4. Special and recognized religious holidays regularly observed by persons of their faith. Any student who misses a class or day of school because of the observance of a day set aside as sacred by
a recognized religious denomination of which the student is a member or adherent, where such religion calls for special observances of such day, shall have the absence from that school day or
class excused and shall be entitled to make up any school work missed without the imposition of any penalty because of the absence.
5. A court order; a subpoena; and/or a legal court summons.
6. Extenuating circumstances over which the student has no control as approved by the principal.
7. If a student's parent, custodian or other person with legal custody or control of the student is a member of the United States Armed Forces, including a member of a state National Guard or a
Reserve component called to federal active duty, the student's Principal shall give the student:
A. An excused absence for one (1) day when the student's parent, custodian or other person with legal custody or control of the student is deployed;
B. An additional excused absence for one (1) day when the student's parent, custodian or other person with legal custody or control of the student returns from deployment; and
C. Excused absences for up to ten (10) days for visitation when the student's parent, custodian or other person with legal custody or control of the student is granted rest and recuperation leave
and is stationed out of the country.
D. Excused absences for up to ten (10) days cumulatively within the school year for visitation during the deployment cycle of the student's parent, custodian or other person with legal custody or
control of the student. Total excused absences under this section (c) and (d) shall not exceed a total of ten (10) days within the school year. The student shall provide documentation to the
school as proof of the deployment of the student's parent, custodian or other person with legal custody or control of the student..
8. Participation in a non-school-sponsored extracurricular activity. A school principal or the principal's designee may excuse a student from school attendance to participate in a non-school-
sponsored extracurricular activity, if the following conditions are met:
(1) The student provides documentation to the school as proof of the student's participation in the non-school-sponsored extracurricular activity; and
(2) The student's parent, custodian, or other person with legal custody or control of the student, prior to the extracurricular activity, submits to the principal or the principal's designee a written
request for the excused absence.
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities
ATTENDANCE, ABSENCES, TRUANCY, AND WITHDRAWAL POLICY-PAGE 3
The written request shall be submitted no later than seven (7) business days prior to the student's absence. The written request shall include:
(A) The student's full name and personal identification number;
(B) The student's grade;
(D) The reason for the student's absence; and
(E) The signature of both the student and the student's parent, custodian, or other person with legal custody or control of the student.
The principal or the principal's designee shall approve, in writing, the student's participation in the non-school-sponsored extracurricular activity. The principal may limit the number and duration
of non-school-sponsored extracurricular activities for which excused absences may be granted to a student during the school year; however, such the principal shall excuse no more than ten (10)
absences each school year for students participating in non-school-sponsored extracurricular activities.
Students receiving an excused absence under this section shall have the opportunity to make up school work missed and shall not have their class grades adversely affected for lack of class
attendance or class participation due to the excused absence. A written statement within two (2) school days of the student's return to school shall be required from the parent or guardian
explaining the reason for each absence. If necessary, verification is required from an official source to justify absences.
All absences other than those outlined above shall be considered unexcused. Parents may appeal unexcused absences to their child’s school principal (or designee). The appeal must be: (1) in
writing and include documentation necessary to support the appeal; (2) submitted within five (5) school days of the parent’s receipt of the first official attendance letter generated by the District
that is referenced in policy 6016 Truancy District; and (3) based on one or more of the allowable reasons for excused absences outlined in this policy. Within five (5) school days of receipt of the
request for appeal, the Principal (or designee) shall review the appeal, meet with the parents to allow them an opportunity to be heard, and render a decision regarding the appeal. The decision of
the principal (or designee) that is compliant with applicable law and district policy is final. (This appeal process for determining unexcused absences is ancillary to a truancy decision rendered by a
juvenile court judge as described in TCA 49-6-3010.) Questions regarding school-level decisions may be directed to the district department responsible for academic school operations. Parents may
direct their questions to the Office of Student Equity, Enrollment, and Discipline (S.E.E.D.) at 901.416.6007.
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities
Parent Signature & Date
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities.
Discipline Plan
(Circle one)
1. Defiance/Mild disrespect to teacher or
students (verbal, i.e., arguing,
walking, horse playing
ignoring safety procedures
8. Abusing hall pass privileges (i.e., slothful
transitions, cutting class, excessive
tardiness, unauthorized area, etc.)
following directions, procedures, rules,
compliance)
11. Use of indirect profanity (not towards
people) (REFFERAL TO PARENT)
The following student behaviors should be managed in the classroom by the teacher(s)
and do not warrant office referrals.
Conference Call + Conduct grade decrease + no
incentive participation
limited time
teacher)
consequence • 1 day of ISS (must be approved by Principal)
Teacher Checklist (Procedures) • Verbal Warning • Inform parents of incident and the outcome • Conduct Grade affected/Loss of incentive
participation/Student receive Consequence • Conduct form (Elementary)/Behavior Log(Middle
• Complete Parent Contact (parent signature required)
• Submit to Principal for discussion/consequence/signature
• Retrieve signed copy and file in student discipline folder
• Collect student statements for Investigation
LEVEL 2 Level 2 Discipline Codes & Offenses (Circle one) Level 2 Consequences: (Circle one)
1. Repeated or extreme insubordination (teacher has evidence of intervention (behavioral contract) but student’s behavior is persistent and non-responsive)
2. Fighting (self-defense) 3. Profanity directed towards staff 4. Weekend Activities that filter into the school 5. Inappropriate use of school electronic devices 6. Sexual, racial, or religious
harassment/discrimination. 7. Obscene gestures-PDA public display of
affection- (NO touching) 8. Refusal to produce an object identified by
metal detectors. 9. Possession of cell phones or other electronic
communication devices during school hours without written permission of the principal
Parent/Teacher Conference Call or Meeting + Conduct grade decreases + No incentive participation
And Grade Chair and/or Principal selects one! • No support (2 days)-inform support
teacher)
• Weekend assignment (Dictionary activity)
• ½ Day of Shadowing or Whole Day of Shadowing
Teacher Checklist Procedures Verbal Warning • Inform parents of incident and the
outcome • Conduct Grade affected/Loss of
incentive participation/Student receive Consequence
• Conduct form (Elementary)/Behavior Log(Middle
• Submit to Principal for discussion/consequence/signature
• Retrieve signed copy and file in student discipline folder
• Collect student statements for Investigations
Student Name:
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities.
LEVEL 3
one)
1. Physical or verbal intimidation (student to student)
2. Profanity directed towards student (i.e., racial slurs, derogatory language)
3. Threatening bodily harm to another student
4. Fighting (not self-defense) 5. Gang activities - any gang related
activity 6. One (1) or more students initiating a
physical attack on an individual student
Contact Parent + Conduct decreases + no incentive participation And Principal selects one • No support (3 days)-inform support teacher
• ISS or Out of School Suspension (3-5 days) • ½ Day of Shadowing or Whole Day of Shadowing Teacher Checklist Procedures Verbal Warning • Inform parents of alleged incident and the
outcome • STAFF CAN NOT SHARE THE ACCUSER’S OUTCOME • Conduct Grade affected/Loss of incentive
participation/Student receive Consequence • Conduct form (Elementary)/Behavior Log(Middle • Complete Office Referral (parent signature
required) • Submit to Principal for
discussion/consequence/signature • Retrieve signed copy and file in student discipline
folder • Collect student statements for Investigations • Forms 1-4 must be completed!
LEVEL 4
Level 4 Discipline Codes & Offenses (Circle one) Level 4 Consequences: (Circle one)
1. Gang activities Stealing of school property 2. Possession of mace or disabling sprays 3. False accusations against school personnel. 4. Threatening bodily harm to school
personnel
Contact Parent + Conduct decreases + no incentive participation
And Principal selects one • In or Out of School Suspension (7-10 days)
Teacher Checklist Procedures Verbal Warning • Inform parents of incident and the outcome • Conduct Grade affected/Loss of incentive
participation/Student receive Consequence • Conduct form (Elementary)/Behavior
Log(Middle)/Live School input (Both) • Complete Office Referral (parent signature
required) • Submit to Principal for
discussion/consequence/signature • Retrieve signed copy and file in student
discipline folder • Collect student statements for
Investigations
Offense 5 Administration shall notify law enforcement and appropriate others for any possible
criminal offenses (i.e., drugs, weapons, etc.)
Parent Signature & Date
Principal-Ms. Marsharee Shaw 901-505-0551
a. Lease agreement in the parent/guardian name
b. Mortgage statement in the parent/guardian name
c. Parent/guardian driver’s license
d. MLGW or telephone bill
e. Any governmental or official court documents with parent/ guardian name and
address (WIC, Families First, child support, etc.)
• Most recent report card
• Certified copy of Birth Certificate
• Social Security card
• Current/valid Immunization record on TN School form (completed within the last 12
months and signed by a doctor/clinic
• Parent/Student/Principal introduction meeting when documentation is submitted.
2. Forms of Proof of Residence
a. Lease agreement in the parent/guardian name
b. Mortgage statement in the parent/guardian name
c. Parent/guardian driver’s license
d. MLGW or telephone bill
e. Any governmental or official court documents with parent/ guardian name and address
(WIC, Families First, child support, etc.)
Check One: Elementary _________________
Student?
Is this student currently under suspension/expulsion at another school?
Has this student been adjudicating (giving a ruling) delinquent for having committed a violent crime?
Has this student ever been previously enrolled in a Shelby County School?
If yes, please list the Tennessee School/SCS School Name, City, Year
Yes _____
No______
Yes _____
No______
Yes _____
No______
Yes _____
No______
DOB: Race Gender
Custody Alert? Yes( ) No( )
If yes, please attach an explanation including a COPY of any court orders
Medic Alert Does the student have any medica conditions? Yes( ) No( )
Is a language other than English spoken in the home?
Yes( ) No( )
Country of Origin Special Education Information Has student ever been enrolled in a Special Education?
(Circle One) Resource 504 Gifted Program
School Last Attended:
City State Zip
Parent Information 2:
City State Zip
Parent Contact
Inclement Weather
Dear Parents/Guardians,
In the event we have an abbreviated school day (due to inclement weather), you can remain informed by going to the
Memphis Business Academy website: https://memphisbusinessacademy.com/
In case school is dismissed early due to inclement weather, my child should use:
______________Usual transportation home (example: car rider or walker) Contact Person #1 Contact Person #2 Contact Person #3
Cell: Cell: Cell:
Relationship to the student: Relationship to the student: Relationship to the student:
I certify that information contained in this application is true and complete. I understand that false information may be grounds for my child to not be accepted into Memphis Business Academy and/or Memphis STEM Academy or dismissed at any point in the future if my child is accepted. I authorize the verification of any or all information listed above. Parent Signature Date
Emergency Contact Information & Inclement Weather
Other persons to call in case of emergency or illness: Only parents/guardians listed below may check out your child. Emergency contacts must be 18 or older and will be required to provide ID.
Student’s Name Grade DOB
Check all that Apply
Anemia Diabetes Leukemia Sinus Problems
Anxiety attack Depression Low Blood Pressure Stroke
Arhritis Dialysis Meningitis Vision Problems
Artifical joints Fractures Menstrual Cramps Vomiting
Artifical valves(heart) Glasses Migraine Headache Speech Problems
Asthma Headaches Nosebleeds
Broken bones Heart Problems Reflux Crutches/Walker
Cancer Hemophilia Rheumatic Fever Wheelchair
Contact lens High Blood Pressure Scoliosis OTHER
Concussion ) Hypoglycemia Seizures
Fish-Milk-Eggs)
Environmental (Trees— Grass-Dust-Dirt)
Insects (Bees- Wasps) Allergies If you have checked any of the aboved please provide specific
information Latex Smoke
Student’s Name Grade DOB
Medical
Medications- Name medications your child takes in additon for the Epi Pen to treat an allergic reaction
Home(Give name, dose, and time taken) School (Give name, does, and time taken)
Physicians
to appropriate school system staff.
Parent signature prohibits disclosure of health information to school staff.
Parent Signature: Parent Signature:
Does your child require health care procedures such as Catheterization—Tube Feeding Yes No
Does your child routinely take medicine at home or at school? Yes No
Does your child require an Epi Pen for an allergic reaction? Yes No
Does your child have severe allergies Yes No
My child has stopped breathing because of an allergic reaction. Yes No
Lunch Information
School Address 4443 S. Germantown Road
Memphis, TN 38125
Do not fill out this section. For school use only Student ID: Y N
Parent Name Street Address City, State, Zip
Students Name Social Security Upcoming Grade Levels Attending Schools Date of Birth Race Gender
Please check TWO boxes below:
Check One Household Size Check One Annual Gross Income Check One Annual Gross Income
1 Between $0-$21,590 Above $21,590
2 Between $0-$29,101 Above $29,101
3 Between $0-$36,612 Above 36,612
4 Between $0-$44,123 Above $ 44,123
5 Between $0-$51,634 Above $51,634
6 Between $0-$59,145 Above $59,145
7 Between $0-$66,656 Above $66,656
8 Between $0-$74,167 Above $74,167
I certify (promise) that all information on this application is true and that all income is reported. I understand that school will receive federal and state funding
based on the information provided. I understand that school officials may verify(check) the information.
Sign and Date:
TRANSFORM FORM
Student Name:
Student Enrollment and Records-also to be used for other select transfers
All applications received between March 26 through April 30 will be sorted by priority category (Sibling, Choice, etc.) and processed “first come, first served” within
priority category. All applications submitted after April 30 will be processed in order of receipt. Applications will be accepted between January-May.
Please select the appropriate legal residency of the Parent/Legal Guardian:
_ City of Memphis _ Non-City __Shelby County Resident*
_ Other TN County* _ State other than TN*
* All non-city residents, except SCS employees who reside within Tennessee, are required to pay tuition and to present receipt at registration.
Type of Transfer Requested
_x Open Enrollment _ Sp Ed Sibling _ Psych/Med _ Other : ____________________________
We must have current and accurate contact information. Any inaccurate information at the time of processing may result in the inability to process your request. If
any contact information changes, you must call the Office of Student Enrollment and Records at 416-5830.
For Sibling Transfer
Brother/sister must have been enrolled in the sibling’s requested school and must
be returning
_____MBAE Berclair _____MSA
Siblings Name Siblings Current School DOB Grade
For School and Office Use only
Student PIN Number: Previous PIN: Approved
By: Date:
Parent Signature & Date:
Tennessee Parent Occupational Survey-Page 1
In order to better serve your child, our school district wants to identify students who may qualify to receive additional educational services, such as tutoring,
school supplies, free or reduced-price lunch, summer camps, and other services. The information provided below will be kept confidential. Please answer the
following questions and return this form to your child’s school.
Today’s Date School Name:
Memphis Business Academy Hickory Hill
Parent/Guardian First & Last Name
Student First & Last Name Student Grade Level:
Have you or an immediate family member performed any of the jobs listed below temporarily or seasonally, in any part of the United States, in the past three
years?
( ) No ( ) Yes Check all that apply and list the total number of months worked.
Agriculture/Field Work (planting, picking, sorting
crops; soil preparation; irrigation; fumigation)
Processing & Packaging (fruit, vegetables, chicken, eggs, pork, beef)
Total Months Worked: Total Months Worked
Dairy/Cattle Raising (feeding, milking, rounding
up)
landscaping not included)
Total Months Worked Total Months Worked
Tennessee Parent Occupational Survey-Page 2
In order to better serve your child, our school district wants to identify students who may qualify to receive additional educational services, such as tutoring,
school supplies, free or reduced-price lunch, summer camps, and other services. The information provided below will be kept confidential. Please answer the
following questions and return this form to your child’s school.
Months Years Weeks
Best Day of the Week & Time of Day to Call
For School Use Only: Please send survey with two YES responses to your district migrant liaison. If you have questions, call (931) 212-9539 to speak with the
Tennessee Migrant Education Program
Primary Home Language Survey
Former Students Do not have to complete this form!
New Students This form must be completed by the parent or legal guardian during registration for ALL NEW MBA/MSA EXECUTIVES
Student Name:
most often outside of school?
What language do people usually speak most often outside of school? What language do people usually speak in the
child’s home?
Does your child have Refugee Status?
Yes No In what language do you want notices sent to you from the
school?
Was this child born in the United States? Yes NIf no, list the birth country:
This section is to be completed only for executives who answered any questions 1-3 with a language other than English. • Category C-Speaks English and the other language equally well. • Category D-Speaks mostly English • Category E-Speaks only English
LAU Category (check one) • Category A-Speaks only the language other than English • Category B-Speaks mostly the language other than English
Signature of Parent/Guardian Signature of Questioner
Month Day Year
____________ A paraprofessional’s qualifications.
____________An annual notice of Student Education Records, Privacy and notice for disclosure of School Directory Information.
____________Their child’s level of achievement of each of the state’s academic assessments.
____________Notification of right to transfer their child to another school in the district if the student becomes the victim of a violent crime or is assigned to an unsafe school.
____________District Family Involvement Policy and School Parent Involvement Policy.
____________Their right to public school choice, and more effective involvement if their child’s school is identified for school improvement.
Parent Signature Date
No Child Left Behind School Parent/Student Compact
Executive Parent/Guardian’s Agreement It is important that I take a
more responsible role in helping my Executive. Therefore, I shall
strive to do the following:
• Provide 20 volunteer hours per year to MBA/MSA ,10 per
semester
• See that my child is punctual, has necessary supplies, and
attends school regularly
• Support MBA in the its efforts to maintain proper discipline
• Establish a time and quiet well-lit place for homework and
review it regularly
• Encourage my child’s efforts and be available for questions
• Stay aware of what my child is learning and communicate
about the progress
• Review, sign, and return all paperwork from MBA
• Arrange for my child to take advantage of after school tutoring
• Make sure that my child wears proper uniform attire every day
• Develop a partnership with MBA to help my child achieve the
highest standards
• Attend schedule parent meetings, conferences, and workshops
MBA/MSA Executive Agreement It is important that I work to the
best of my ability. Therefore, I shall strive to do the following:
• Attend school regularly, arrive on time, and actively participate in
all classes
• Do my best to do quality work at all times
• Observe regular study hours
Executive conduct and follow classroom policies and procedures.
• Wear uniforms everyday
Parent Signature: Student Name:
• @ACCESS RELEASE AND AUTHORIZATION FORM
• As a condition of using the MBA/MSA network, I agree to comply with the E-mail and Internet Acceptable User Agreement
(“Agreement”). I have read, and I understand the Agreement. Should I commit any violation, my access privileges may be revoked, and
disciplinary action may be taken, including suspension/expulsion.
• @I UNDERSTAND THAT MY MBA NETWORK ACCOUNT IS NOT PRIVATE. I CONSENT TO MBA/MSA MONITORING ALL MY ACTIVITIES ON
THE NETWORK, INCLUDING E-MAIL, INTERNET ACTIVITY, AND ALL FILES AND DOCUMENTS STORED IN THE MBA NETWORK.
• @As a parent or legal guardian of the child who signed above, I grant permission for him/her to access networked computer services such
as e-mail and the internet. I understand that (s)he is expected to use good judge and follow rules and guidelines set forth in the
Acceptable Use Agreement (“Agreement”). MBA/MSA cannot be responsible for the child’s use of the MBA/MSA network, including any
ideas and concepts that (s)he may gain by his/her use of the Internet or for the actions that (s)he takes through the use of the Internet. I
release MBAE/MSA, the school, their officers, agents, and employees, from all costs, claims, and liability resulting from the use of the
MBA/MSA network by the child.
• I have read the Agreement and accept the rules and conditions in the Agreement. I release MBAE/MSA, the school, their officers,
employees, and agents from any claim arising out of the child’s use of the MBA/MSA network. I agree to indemnify and to hold harmless
MBAE/MSA, the school, their officers, employees, and agents from any costs, liability, or claims arising from the child’s use of the
MBA/MSA network.
Student Name:
• @To protect the privacy of your Executive while enrolled at Memphis Business Academy/Memphis STEM Academy, there is a policy
governing the confidentiality of child information. As part of the policy, we will not allow your child to be videotaped or
photographed by anyone who is not a SCS Board, MBA/MSA Approved Organization, and/or Staff member of MBA/MSA, without
your permission.
• @The purpose of this form is to provide you with the opportunity to deny permission for your child to be videotaped or
photographed as a normal part of school activities from outside groups, such as the newspaper, media, or special programs within
the district.
• @If you agree, your child may participate in programs or other activities that could be videotaped or photographed for publicity or
news stories. Your child may appear in or on the following media: brochures, videos, newsletter, radio talk shows, newspaper
articles or television news, which may be used to promote MBA/MSA or the school district.
• @I understand that any media and video opportunities will be in line with the mission and educational philosophy of MBA/MSA and
SCS.
Check One
____Yes, my Child may participate. ___No, my Child may not participate
Parent Signature & Date
CODE OF CONDUCT
Parent Consent for Corporal Punishment
In addition to the MBA/MSA Code of Conduct that is available in the MBA/MSA Handbook, I am aware that MBA has instituted a
Corporal Punishment as a form of discipline with parent consent.
Check One
_____________ I agree that my child will receive corporal punishment for discipline infractions.
_____________ I do not agree that my child will receive corporal punishment for discipline infractions.
Comments:
Student Name: Parent Signature & Date
Attendance The Tennessee State Compulsory Attendance Law (T.C.A.§49-6-3001 and T.C.A. §49-6-2007) requires that pupils of legal age attend school (ages of six and seventeen years, both
inclusive) unless special circumstances arise which temporarily or permanently excuse the student from attendance. This also applies to five (5) year old students who have attended school for six
(6) weeks. By state law, the student’s school year shall consist of a minimum of 180 teaching days exclusive of all vacations, as approved by the board of education. (T.C.A.§49-6-3004) The annual
calendar is divided into two semesters. A copy of this calendar is included at the front of this handbook.
Enrollment of Students Beyond Compulsory Attendance Age (Policy #6010) During the first twenty (20) days, students beyond compulsory attendance age [eighteen (18) years of age or older]
who have been continuously enrolled with the district may register for school through the standard registration process. However, upon enrollment, all such students shall meet with their school
principals and other appropriate staff to evaluate academic options and make appropriate education placement referrals for the students, including overage for grade students; and outline the
academic and behavioral expectations of the student within the school. SCS Student Handbook 12 2019-2020 An application for admission must be evaluated for approval by the principal for a
person eighteen (18) years of age or older who:
1. has dropped out of school and wants to re-enter; or
2. 2. fails to enroll within twenty (20) school days after school officially starts, unless one or more of the following applies:
A. The student can show proof of satisfactory attendance in another school system during the first twenty (20) day period.
B. A doctor's certificate states that illness has prevented enrollment during the first twenty (20) day period.
C. The district is required to permit the student to enroll under the Individuals with Disabilities Education Act.
Students not initially accepted for enrollment by the principal may then contact the district department responsible for student services for possible enrollment.
Attendance of Students Beyond Compulsory Attendance Age (Policy # 6011) Any student having passed the compulsory attendance age may be dropped from the rolls after three (3) consecutive
unexcused absences, or an aggregate five (5) unexcused absences, from class or school, upon approval of the superintendent (or designee).
Compulsory Attendance (Policy# 6012) Students between the ages of six (6) and seventeen (17), both inclusive, must attend a public or non-public school. The principal shall be responsible for
the initial placement of students entering school for the first time. A parent/guardian or legal custodian who believes that their child is not ready to attend school at the designated age of
mandatory attendance may make application to the superintendent (or designee) for a one (1) semester or one year deferral in required attendance. Any such deferral shall be communicated to
the principal of the school that the student would have attended. In accordance with the provisions outlined in the state law, the Board may temporarily excuse students from complying with the
provisions of the compulsory attendance law.
Truancy (Policy #6016) Unauthorized absence from school is considered truancy and will be treated as such. This includes absence from any class, study hall, or activity during the school day for
which the student is scheduled and remedial programs that are offered at no cost to parents provided that prior to requiring the student to attend the program a commitment of transportation is
provided to those students who qualify for transportation to and from school. The principals, in coordination with any teachers who provide instruction to a student and any other appropriate
school faculty, shall make the decision to require the student's attendance at such remedial instruction SCS Student Handbook 14 2019-2020 occurring outside of the regular school day, including
but not limited to programs conducted during the summer and after the conclusion of the regular school day pursuant to state law.
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities
ATTENDANCE, ABSENCES, TRUANCY, AND WITHDRAWAL POLICY-PAGE 2
Make-up Work-In the event of an excused absence, students are expected to make up work missed within a reasonable time. In the event of an unexcused absence, one day of makeup time shall
be allowed for each day of unexcused absence, if the following conditions are met. The parent of a student or a student with an unexcused absence must submit a written request to the teacher
to makeup the work and must participate in an appropriate intervention (e.g., student or parent conference with the teacher, Saturday school, online tutorial, other appropriate intervention
determined and scheduled by the teacher). For absences due to long-term suspension (over 10 days)/expulsion, the program of making up work shall be in accordance with state law
Attendance and Excuses (Policy #6014) The Shelby County Board of Education believes that regular attendance is a necessary requirement of all students. All students are expected to attend
school on each day that school is officially in session and remain at school for the entirety of the school day. Only the following reasons will be considered for excused absences:
1. Illness, injury, pregnancy, homebound circumstance, or hospitalization of student. The District may require a parent conference and/or physician verification to justify absences after the
accumulation of ten (10) days of absence during a school year. Notes must be date specific and will be required for subsequent absences beyond ten (10) days.
2. Death or serious illness within the student's immediate family.
3. When the student is officially representing the school in a school sponsored activity or attendance at school-endorsed activities and verified college visits.
4. Special and recognized religious holidays regularly observed by persons of their faith. Any student who misses a class or day of school because of the observance of a day set aside as sacred by
a recognized religious denomination of which the student is a member or adherent, where such religion calls for special observances of such day, shall have the absence from that school day or
class excused and shall be entitled to make up any school work missed without the imposition of any penalty because of the absence.
5. A court order; a subpoena; and/or a legal court summons.
6. Extenuating circumstances over which the student has no control as approved by the principal.
7. If a student's parent, custodian or other person with legal custody or control of the student is a member of the United States Armed Forces, including a member of a state National Guard or a
Reserve component called to federal active duty, the student's Principal shall give the student:
A. An excused absence for one (1) day when the student's parent, custodian or other person with legal custody or control of the student is deployed;
B. An additional excused absence for one (1) day when the student's parent, custodian or other person with legal custody or control of the student returns from deployment; and
C. Excused absences for up to ten (10) days for visitation when the student's parent, custodian or other person with legal custody or control of the student is granted rest and recuperation leave
and is stationed out of the country.
D. Excused absences for up to ten (10) days cumulatively within the school year for visitation during the deployment cycle of the student's parent, custodian or other person with legal custody or
control of the student. Total excused absences under this section (c) and (d) shall not exceed a total of ten (10) days within the school year. The student shall provide documentation to the
school as proof of the deployment of the student's parent, custodian or other person with legal custody or control of the student..
8. Participation in a non-school-sponsored extracurricular activity. A school principal or the principal's designee may excuse a student from school attendance to participate in a non-school-
sponsored extracurricular activity, if the following conditions are met:
(1) The student provides documentation to the school as proof of the student's participation in the non-school-sponsored extracurricular activity; and
(2) The student's parent, custodian, or other person with legal custody or control of the student, prior to the extracurricular activity, submits to the principal or the principal's designee a written
request for the excused absence.
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities
ATTENDANCE, ABSENCES, TRUANCY, AND WITHDRAWAL POLICY-PAGE 3
The written request shall be submitted no later than seven (7) business days prior to the student's absence. The written request shall include:
(A) The student's full name and personal identification number;
(B) The student's grade;
(D) The reason for the student's absence; and
(E) The signature of both the student and the student's parent, custodian, or other person with legal custody or control of the student.
The principal or the principal's designee shall approve, in writing, the student's participation in the non-school-sponsored extracurricular activity. The principal may limit the number and duration
of non-school-sponsored extracurricular activities for which excused absences may be granted to a student during the school year; however, such the principal shall excuse no more than ten (10)
absences each school year for students participating in non-school-sponsored extracurricular activities.
Students receiving an excused absence under this section shall have the opportunity to make up school work missed and shall not have their class grades adversely affected for lack of class
attendance or class participation due to the excused absence. A written statement within two (2) school days of the student's return to school shall be required from the parent or guardian
explaining the reason for each absence. If necessary, verification is required from an official source to justify absences.
All absences other than those outlined above shall be considered unexcused. Parents may appeal unexcused absences to their child’s school principal (or designee). The appeal must be: (1) in
writing and include documentation necessary to support the appeal; (2) submitted within five (5) school days of the parent’s receipt of the first official attendance letter generated by the District
that is referenced in policy 6016 Truancy District; and (3) based on one or more of the allowable reasons for excused absences outlined in this policy. Within five (5) school days of receipt of the
request for appeal, the Principal (or designee) shall review the appeal, meet with the parents to allow them an opportunity to be heard, and render a decision regarding the appeal. The decision of
the principal (or designee) that is compliant with applicable law and district policy is final. (This appeal process for determining unexcused absences is ancillary to a truancy decision rendered by a
juvenile court judge as described in TCA 49-6-3010.) Questions regarding school-level decisions may be directed to the district department responsible for academic school operations. Parents may
direct their questions to the Office of Student Equity, Enrollment, and Discipline (S.E.E.D.) at 901.416.6007.
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities
Parent Signature & Date
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities.
Discipline Plan
(Circle one)
1. Defiance/Mild disrespect to teacher or
students (verbal, i.e., arguing,
walking, horse playing
ignoring safety procedures
8. Abusing hall pass privileges (i.e., slothful
transitions, cutting class, excessive
tardiness, unauthorized area, etc.)
following directions, procedures, rules,
compliance)
11. Use of indirect profanity (not towards
people) (REFFERAL TO PARENT)
The following student behaviors should be managed in the classroom by the teacher(s)
and do not warrant office referrals.
Conference Call + Conduct grade decrease + no
incentive participation
limited time
teacher)
consequence • 1 day of ISS (must be approved by Principal)
Teacher Checklist (Procedures) • Verbal Warning • Inform parents of incident and the outcome • Conduct Grade affected/Loss of incentive
participation/Student receive Consequence • Conduct form (Elementary)/Behavior Log(Middle
• Complete Parent Contact (parent signature required)
• Submit to Principal for discussion/consequence/signature
• Retrieve signed copy and file in student discipline folder
• Collect student statements for Investigation
LEVEL 2 Level 2 Discipline Codes & Offenses (Circle one) Level 2 Consequences: (Circle one)
1. Repeated or extreme insubordination (teacher has evidence of intervention (behavioral contract) but student’s behavior is persistent and non-responsive)
2. Fighting (self-defense) 3. Profanity directed towards staff 4. Weekend Activities that filter into the school 5. Inappropriate use of school electronic devices 6. Sexual, racial, or religious
harassment/discrimination. 7. Obscene gestures-PDA public display of
affection- (NO touching) 8. Refusal to produce an object identified by
metal detectors. 9. Possession of cell phones or other electronic
communication devices during school hours without written permission of the principal
Parent/Teacher Conference Call or Meeting + Conduct grade decreases + No incentive participation
And Grade Chair and/or Principal selects one! • No support (2 days)-inform support
teacher)
• Weekend assignment (Dictionary activity)
• ½ Day of Shadowing or Whole Day of Shadowing
Teacher Checklist Procedures Verbal Warning • Inform parents of incident and the
outcome • Conduct Grade affected/Loss of
incentive participation/Student receive Consequence
• Conduct form (Elementary)/Behavior Log(Middle
• Submit to Principal for discussion/consequence/signature
• Retrieve signed copy and file in student discipline folder
• Collect student statements for Investigations
Student Name:
The MBA Experience: Growing tomorrow’s leaders to transform lives and communities.
LEVEL 3
one)
1. Physical or verbal intimidation (student to student)
2. Profanity directed towards student (i.e., racial slurs, derogatory language)
3. Threatening bodily harm to another student
4. Fighting (not self-defense) 5. Gang activities - any gang related
activity 6. One (1) or more students initiating a
physical attack on an individual student
Contact Parent + Conduct decreases + no incentive participation And Principal selects one • No support (3 days)-inform support teacher
• ISS or Out of School Suspension (3-5 days) • ½ Day of Shadowing or Whole Day of Shadowing Teacher Checklist Procedures Verbal Warning • Inform parents of alleged incident and the
outcome • STAFF CAN NOT SHARE THE ACCUSER’S OUTCOME • Conduct Grade affected/Loss of incentive
participation/Student receive Consequence • Conduct form (Elementary)/Behavior Log(Middle • Complete Office Referral (parent signature
required) • Submit to Principal for
discussion/consequence/signature • Retrieve signed copy and file in student discipline
folder • Collect student statements for Investigations • Forms 1-4 must be completed!
LEVEL 4
Level 4 Discipline Codes & Offenses (Circle one) Level 4 Consequences: (Circle one)
1. Gang activities Stealing of school property 2. Possession of mace or disabling sprays 3. False accusations against school personnel. 4. Threatening bodily harm to school
personnel
Contact Parent + Conduct decreases + no incentive participation
And Principal selects one • In or Out of School Suspension (7-10 days)
Teacher Checklist Procedures Verbal Warning • Inform parents of incident and the outcome • Conduct Grade affected/Loss of incentive
participation/Student receive Consequence • Conduct form (Elementary)/Behavior
Log(Middle)/Live School input (Both) • Complete Office Referral (parent signature
required) • Submit to Principal for
discussion/consequence/signature • Retrieve signed copy and file in student
discipline folder • Collect student statements for
Investigations
Offense 5 Administration shall notify law enforcement and appropriate others for any possible
criminal offenses (i.e., drugs, weapons, etc.)
Parent Signature & Date