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SCHOOL NAME: West Jefferson High School Verification of Implementation of the Positive Behavior Interventions and Supports Process (PBIS) for Inclusion in the Monitoring Report for the Corrective Action Plan (CAP) 2011-2012 To demonstrate compliance with the CAP as it pertains to PBIS, all schools will have to demonstrate verification of PBIS implementation by providing the following information to the School Safety & Discipline Office by the date indicated. Each report should include the following Critical Elements and their Benchmarks of Quality: CHECK LIST OF ITEMS TO BE INCLUDED IN PBIS IMPLEMENTATION PLAN Mission Statement (benchmark 4) List of PBIS Team Members (benchmark 1-3) Faculty Commitment (benchmark 5-7) Effective Procedures for Dealing with Discipline (benchmark 8-14) Data Entry & Analysis Plan Established (benchmark 15-19) Expectations & Rules Developed (benchmark 20-24) Reward/Recognition Program Established (benchmark 25-32) Lesson Plans for Teaching Expectations/Rules (benchmark 33- 38) Implementation Plan (benchmark 39-45) Crisis Plan (benchmark 46-48) – DO NOT INCLUDE IN PBIS PLAN - Emergency Management Plan that was submitted on September 1, 2011 to School Safety and Discipline Office (include Verification Form only) Evaluation (benchmark 49-53) (See attached Louisiana School- Wide Benchmarks of Quality.) The School Master Plan for Discipline Forms (2) must be completed and included in your PBIS Implementation Plan
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SCHOOL NAME: West Jefferson High School

Verification of Implementation of thePositive Behavior Interventions and Supports Process (PBIS)

for Inclusion in the Monitoring Report for the Corrective Action Plan (CAP)

2011-2012

To demonstrate compliance with the CAP as it pertains to PBIS, all schools will have to demonstrate verification of PBIS implementation by providing the following information to the School Safety & Discipline Office by the date indicated.

Each report should include the following Critical Elements and their Benchmarks of Quality:

CHECK LIST OF ITEMS TO BE INCLUDED IN PBIS IMPLEMENTATION PLAN Mission Statement (benchmark 4) List of PBIS Team Members (benchmark 1-3) Faculty Commitment (benchmark 5-7) Effective Procedures for Dealing with Discipline (benchmark 8-14) Data Entry & Analysis Plan Established (benchmark 15-19) Expectations & Rules Developed (benchmark 20-24) Reward/Recognition Program Established (benchmark 25-32) Lesson Plans for Teaching Expectations/Rules (benchmark 33-38) Implementation Plan (benchmark 39-45) Crisis Plan (benchmark 46-48) – DO NOT INCLUDE IN PBIS PLAN - Emergency Management Plan that was submitted on September 1, 2011 to School Safety and Discipline Office (include Verification Form only) Evaluation (benchmark 49-53) (See attached Louisiana School-Wide Benchmarks of Quality.) The School Master Plan for Discipline Forms (2) must be completed and included in your PBIS Implementation Plan Verification for Required Attached Documents for PBIS Model Master Plan 2011-2012 Form

Implementation Plan, Model Master Plan and this checklist are due November 11, 2011 (Due for Technical Assistance schools on October 14, 2011)

Please forward ONE hard copy of the report via pony to the School Safety & Discipline Office by the appropriate date to the attention of Carol Mancuso c/o Shannon Cummings. Please keep a copy on file in your school office and copies available for your PBIS Team and faculty. The report will be kept on file at our office as part of the CAP Monitoring Plan.

Thank you for all you do to keep our schools a safe place for our students to learn.

PLEASE INCLUDE A COPY OF THIS CHECK LIST WITH YOUR PLAN/tt/file_convert/54544c75af79592e458b6866/document.doc

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VERIFICATION FOR REQUIRED ATTTACHED DOCUMENTS FOR

PBIS MODEL MASTER PLAN2011-2012

SCHOOL

PBIS TEAM LEADER

PRINCIPAL

DATE

_______A copy of the Emergency Management Plans has been placed in every Teacher Emergency Kit which has been strategically placed in each classroom.

Date

_______ A copy of the Emergency Management Plan has beensent to the School Safety and Discipline Office.

Date

_______ A copy of the SIP is available at school site for review.

Date

Principal’s signature

The PBIS Model Master Plan requires the School Improvement Plan (SIP) and Crisis Plan. This verification form assures that a copy of each plan is on file and available for review at your school.

This form is to be submitted with PBIS Implementation Plan./tt/file_convert/54544c75af79592e458b6866/document.doc

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Mission Statement

School VisionStudents will leave WJHS college and career ready and will become stewards and leaders in our community.  School MissionIn partnership with families and the community, WJHS will:

o provide safe and supportive learning environments o present engaging, relevant, rigorous, and technologically rich educational experiences o ensure the success of every student

 School MottoI am a BUC.When I am RESPECTFUL, RESPONSIBLE, PERSISTANT and CONFIDENT,I have the POWER to succeed.I WILL SUCCEED.I am a BUC. 

SWPBIS MissionResearch and implement interventions grounded in data so that teachers can teach, students can learn and every member of the school community feels valued and respected.

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SWPBIS Team Members

Larry SaveryAssistant Principal

Team Leader

Secretary

Data Manager

Team Member

Team Member

Team Member

Team Member

Team Member

Team Member

Team Member

Team Member

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Faculty Commitment

During a professional learning community meeting, Larry Savery, the Assistant Principal for Student Services, led faculty members in constructing their 3-5 positively stated classroom rules. These rules were aligned with the SWPBIS expectations but grounded in what the teachers thought were the main problems in their classroom. The teachers also thought of their 4 step consequence ladder, with the referral being the result of the 4th minor infraction. Lastly, they thought of their rewards and incentives. These rules, consequences and incentives were posted in every classroom and checked for compliance by the Student Services office. In addition, teachers were required to modify the Minor Infraction Form with their rules on it so that they were clearly implementing their rules and using them to manage their classroom.

INSERT DATES AND SLIDES FROM PROFESSIONAL DEVELOPMENT

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Effective Procedures for Dealing with Discipline

The faculty and staff will be provided with staff development on the discipline process. Procedures for handling both minor and major infractions will be outline and/or discussed during staff development, professional learning communities, and in the faculty handbook. Faculty and staff will be informed of the procedure for documenting infractions during staff development meetings and through faculty memos.

Discipline referrals will include name, date, time, grade, location, referring staff member, race, special education or regular education classification, problem behavior, motivation, others involved, and administrative action.

The faculty handbook will include information about both minor and major infractions and their consequences. These infractions will be defined and discussed during faculty and professional learning community meetings. Appropriate responses to behaviors will be discussed.

Insert blank copy of the referral

Minor Infractions Willful disobedience Refusal to provide identification/name Class or campus disturbance Name-calling/taunting Profanity, obscenity (verbal or written), abusive

or disrespectful language Entering/leaving through wrong gate Forgery/cheating Pushing or shoving Running in the hallway Eating without permission Sleeping Talking without permission Uniform violations Yelling, screaming or loud talking in building Failure to submit homework Tardiness to school

Major Infractions Willful and disrespectful disobedience Physical abuse of school personnel Threatening school personnel Indecent behavior/inappropriate touching Threatening or intimidating students Hitting, pushing, shoving, kicking, biting or any

physical abuse of students Fighting Body injury to student Stealing or possession of stolen property Possession, display or use of matches, lighters,

tobacco Possession, display or use of weapons Possession or display of weapon facsimiles Possession, display or use of drugs, alcohol or

inhalants Possession, display or use of fireworks or explosives Blackmail or extortion Vandalism at school or school functions Damage to school property Refusal to provide identification/name Leaving class without permission Leaving campus/truancy/trespassing In an unauthorized area without permission Misrepresents facts or makes false statements Major class or campus disturbance Name-calling and taunting Bullying Forgery/cheating Unwanted physical contact with another student Instigating arguments or fights through gossip,

taunting or teasing Repeated uniform violations Possession or use of a cell phone/electronic device Circumventing testing procedures Repeated tardiness to school

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Data Entry and Analysis Plan

Whenever possible, data concerning infractions will be entered within two days of the occurrence. At a minimum, information will be entered weekly. Minor infractions will be submitted using the “Classroom Intervention Form.” Upon the fourth minor infraction, a referral will be written.

Monthly reports will be printed and analyzed during monthly SWPBIS meetings. Information from the reports will be included in faculty notes and distributed during professional learning community meetings.

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Expectations and Rules Developed

Be ThereBe in the designated area, at the designated time – physically and mentally.

Understand Your PurposeUnderstand what is expected of you while in that area.

Choose Your AttitudeComplete your business with the appropriate attitude.

SucceedWhen you are there, understand your purpose and choose the right attitude – you succeed by learning and not receiving negative consequences.

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Space Be There Understand Your Purpose

Choose Your Attitude

S u c c e e dClassroom Be on time

Have all supplies needed

Pay attention to the lesson

Contribute to the lesson

Give 100%Take charge of your own education

Actively and appropriately participate

Know your objective

Be patient with the needs of others

Be respectful to yourself and others

Maintain a positive attitude

Pay attentionOffice Stay in waiting area

Present your ID Uniform in tact

Sign in and sign out of office

Line up in orderly fashionRespect time of office staff

Quietly and respectfully complete your business

Bathroom Only go during designated times

Have your pass

Quickly complete your business

Maintain hygiene

Act maturely and responsibly

Cafeteria Only at lunch during designated time

Stay at your place in line Present your lunch

number

Clean your tableThink about what you’re eating

Pause and recharge

Speak in appropriate voice Socialize responsibly Restore order to your

eating space

Hallway Only at transition or with a pass

ID properly displayed Walk at a steady pace Be in appropriate hallway Listen for instructions

Report quickly to your destination

Get to class on timeHonor the space of othersHave your agenda with you at all times

Respond respectfully to others

Use appropriate volume Smile Be mature

Health Center

Have proper pass Get there in a timely

fashion Return promptly to class

Healthy students are attentive students

Go only when you have to go

Non-emergencies may be rescheduled

Ask politely Be honest and up front

about your needs

Library Follow sign-in procedures Only go with designated

class or with signed agenda

On your own, you can go before school, during lunch or after school

Be respectful of othersAcademic use onlyUse materials for intended purposes

Respect others and resources

Ask for assistance when necessary

Act responsibly by returning materials on time

Faculty Be on time Be at door Get students moving

Submit to administration and present to students engaging, rigorous and technology rich lessons

Get your students involvedOvercome obstaclesSet goals

Be concerned Encourage achievement Keep students motivated

Gym Auditorium

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Reward and Recognition Program Established

Buc BucksBuc Bucks are green tickets for students who demonstrate BUCS expectations. Students can do two things with them: 1) Turn them into the office for daily drawings or 2) Hold on to them and spend them in the SWPBIS store for items determined by the team. These items include school t-shirts or spirit gear, the rights to a bulletin board for 1 week, or lunch for the student and 5 friends.

10 Minutes Early to LunchThese passes are given to students who go above and beyond and live the expectations. It allows students to leave their 3rd period class with their teacher’s permission to go to lunch early. These are also used for students who are Student of the Week.

Blue Jeans DayThese passes are given to students who go above and beyond and live the expectations. It allows students to wear jeans that are not too baggy or too tight. These are also used for students who are Student of the Week.

T-Shirt DayThese passes are given to students who go above and beyond and live the expectations. It allows students to wear an appropriate t-shirt to school. These are also used for students who are Student of the Week.

Free Concession ItemThese passes are given to students who go above and beyond and live the expectations. It allows students to receive one item that is $2 or less from the school concession stand. These are also used for students who are Student of the Week.

Front of the Lunch LineThese passes are given to students who go above and beyond and live the expectations. It allows students to skip the lunch line in the cafeteria. These are also used for students who are Student of the Week.

Sweet TreatsThese passes were used for students with perfect attendance for the entire semester. The entire faculty made baked goods for the students and these passes allowed students to obtain several snacks on a particular day during lunch.

Here On Time (HOT)Students are to class on time are rewarded with HOT rewards. These HOT rewards come in the form of hot chips, fireball candy or spicy treats. These days are determined by the team and not told to students so they are not expected.

FreshStudents who are in full uniform are rewarded with a FRESH reward. The FRESH reward comes in the form of a mint. These days are determined by the team and not told to students so they are not expected.

Student of the WeekTeachers submit two students for the Student of the Week by Friday. On Tuesday they are given certificates for their students. Two students from every grade level are chosen to be the spotlight student of the week and are given additional incentives and have their name on the Student of the Week bulletin board.

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Lesson Plans for Teaching Rules and Expectations

Students will learn the expectations through a series of videos that were created by team members and their students. The videos focus on particular areas, including the library, hallway and offices. These public areas seem to be the most confusing. Teachers will also model the behaviors expected in their classrooms through their individual classroom management plans.

The Advisory classroom will also provide an avenue for ancillary topics to be discussed. These include: dealing with grief, handling conflict respectfully, planning for the future, de-escalation, self-esteem, action planning for multiple tasks, etc. While these sessions do not directly deal with expectations, there is no doubt that the behaviors discussed will directly impact the SWPBIS expectations.

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Implementation Plan

CALENDAR.WHAT WAS DONE MONTH BY MONTH FOR SWPBIS

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Crisis Plan

The Crisis Plan is on file in the main office.

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Evaluation

Information will be gathered and analyzed about the SWPBIS program through staff and student surveys and focus groups. An analysis of data will be made at the end of each year to determine if discipline documentation was appropriate and if the staff and faculty used the reinforcement system appropriately. An analysis of all monthly reports will be made by the SWPBIS team and the outcomes will be used in future planning. In addition, monthly meetings with the principal and SWPBIS team leader will ensure that school and team priorities are aligned.

INCLUDE BENCHMARKS OF QUALITY FINALIZED

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The School Master Plan for Discipline

Positive Behavior Intervention Support

In order to assure classroom management using positive behavioral supports and effective disciplinary tools, WEST JEFFERSON HIGH SCHOOL will identify data-driven academic, career and technical, discipline/behavioral performance results in the School Improvement Plan (SIP). WEST JEFFERSON HIGH SCHOOL will establish and use a school-based leadership team to meet on a regularly scheduled basis to review data and guide the positive behavior process. This leadership team shall, to the extent possible, include representatives of the school administration, both regular and special education teachers, parents, guidance counselors, and school bus operators (It may also include other groups, e.g., food services workers).

The leadership team will use a decision-making process utilizing a data-management system that allows graphical representation of discipline issues. Said data system will permit regular and efficient monitoring and evaluation of the effectiveness of the implementation of a school-wide system of discipline. School data collection shall include, but not be limited to, average referrals per day per month, referrals by problem behavior, referrals by location, referrals by time, referrals by student, referrals by staff, individual student report by month and by year, and referrals by grade level. Environmental changes may be made as indicated by data. For instance, increased monitoring, schedule changes, or changes in recess structure may help to alleviate congestion or over- crowding at certain times during the day.

Leadership Team is fully implementing the requirements of R.S. 17:252(D), as required by the provisions of Act 136 enacted by the 2010 Regular Session of the Louisiana Legislature (as contained in its Master Plan for Discipline Worksheet attached).

Leadership Team is ensuring that the school affords itself the opportunity to have all applicable personnel, including classroom teachers, participate in classroom management courses required by Act 136 (as contained in its Master Plan for Discipline Worksheet attached).

The team will uniformly use the two BESE-approved forms, i.e., “School Behavior Report Form” and “School Bus Behavior Report Form,” to report incidents of alleged discipline violations. The referral system will be utilized consistently and appropriately.

The leadership team will review and revise any Zero Tolerance Policy of WEST JEFFERSON HIGH SCHOOL to ensure that the policy is in compliance with R. S. 17:416.15; the policy does not violate R. S. 17:416 (H) which prohibits disciplinary action against any pupil reasonably acting in self-defense; and that inappropriate referrals are not made to agencies serving children.

The leadership team will review and revise its policies and procedures for handling suspensions and expulsions at WEST JEFFERSON HIGH SCHOOL to ensure that suspension/expulsion policies are consistent with R. S. 17.416; suspension/expulsion policies are consistently and fairly executed; and alternative interventions, consistent with best theory and practice, to suspensions/expulsions are used including, but not be limited to, counseling, conflict resolution, social and family responsibility, peer mediation, and stress and/or anger management.

The leadership team will make referrals, as appropriate, to Alternative Education Programs that are designed to offer variations of traditional instructional programs, as well as strategies for the purpose of increasing the likelihood that students who are unmotivated or unsuccessful in traditional programs, or are disruptive in the traditional school environment, remain in and be successful in school.

The leadership team will review the current Code of Student Conduct of WEST JEFFERSON HIGH SCHOOL to assure that it is in compliance with R.S.17:416.12, R.S. 17:416.13 and Section 4114 of the No Child Left Behind Act of 2001 (NCLB). They will refine consequences to create a reward/incentives program for positive student and teacher behavior and ensure the delivery of consistent reinforcement. The team will define consequences for rule violations that are clear, reasonable, and consistently enforced and which support maximum time in instruction.

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The leadership team will monitor, evaluate and modify the school master plan, as needed, throughout the school year.

WEST JEFFERSON HIGH SCHOOL adopts the following clearly defined behavioral expectations in these five (can be less) basic rules. (Keep them simple and positive, e.g., "Keep your hands to yourself.” "Respect others." "Be kind.")

1. Be There

2. Understand Your Purpose

3. Choose Your Attitude

4. Succeed

These rules shall be posted in prominent places around the school site, e.g., hallways, cafeterias, gymnasiums, and classrooms. These rules shall be provided to parents and shall be known by all students and school staff. Each teacher at WEST JEFFERSON HIGH SCHOOL shall develop lesson plans and teach expectations across each school setting by providing direct instruction on expected behaviors at the beginning of the school year and reinforced throughout the year for all students.

WEST JEFFERSON HIGH SCHOOL shall design programs for students with special needs so that the students are challenged and engaged in school curriculum, and are appropriately placed so they remain in school rather than being suspended/expelled or becoming drop-outs.

The principal of WEST JEFFERSON HIGH SCHOOL shall submit annual reports to the district’s Discipline Policy Review Committee.

Safe School Planning

WEST JEFFERSON HIGH SCHOOL has established and shall maintain grade-appropriate programs of alcohol, drug and substance prevention, education, information and counseling as provided in R.S. 17:404.

WEST JEFFERSON HIGH SCHOOL has established a plan, in accordance with Sec. 4114, of the No Child Left Behind Act of 2001, for keeping the school safe and drug-free that includes appropriate and effective school discipline policies that prohibit disorderly conduct, the illegal possession of weapons, and the illegal use, possession, distribution, and sale of tobacco, alcohol, and/or other drugs; has established security procedures at school and while students are on the way to and from school; has established prevention activities that are designed to create and maintain safe, disciplined, and drug-free environments; has established a crisis management plan for responding to violent or traumatic incidents on school grounds; and has established a Code of Student Conduct (and as also required by R.S. 17:416.12 and R.S. 17:416.13) for all students that clearly states the responsibilities of students, teachers, and administrators in maintaining a classroom environment that allows a teacher to communicate effectively with all students in the class; allows all students in the class to learn; allows all students and school employees to be treated respectfully; has consequences that are fair and developmentally appropriate; considers the student and the circumstances of the situation; and, is enforced accordingly.

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Parental and Community Involvement

WEST JEFFERSON HIGH SCHOOL is committed to parental involvement and family strengthening. As set forth in R. S. 17:406.1, effective approaches to involving families more fully as partners in the process of their children’s learning require the participation and coordination of numerous state and local, public and private agencies shall be encouraged WEST JEFFERSON HIGH SCHOOL shall seek to make connections through a variety of local and culturally sensitive methods to facilitate parents/family members/access to local/regional family strengthening programs available in the community. (Programs can be specifically identified, as applicable, e.g., Families Helping Families, Regional Family Resource centers, Parent Information Resource Center, Families In Need of Services [FINs] programs and other family strengthening programs exhibiting peer to peer support systems and positive mental health initiatives).

WEST JEFFERSON HIGH SCHOOL shall seek training to facilitate mutual understanding of research-based practices promoting positive relationships between parents, LEA personnel and community service providers. WEST JEFFERSON HIGH SCHOOL shall seek to identify the mental health needs of its students and match those needs with available local resources including public, nonpublic and/or volunteer organizations (These can be specified to the extent possible). Pending inclusion of mental health services in the Medicaid Health Services Program (School-Based), the availability of mental health services will be expanded in WEST JEFFERSON HIGH SCHOOL.

Inter-Agency Cooperation

WEST JEFFERSON HIGH SCHOOL shall seek to improve communication, coordination and collaboration between schools and agencies serving children; shall foster cooperation regarding the sharing of data about children, youth and families involved agencies serving children; and shall work in cooperation with other schools/districts/communities/regional planning boards to facilitate the successful re-entry and transition of youth formerly in state custody into their diverse school/community settings in order to encourage the continuation of education and their access to other needed services in order to prevent recidivism. Student Records

WEST JEFFERSON HIGH SCHOOL shall provide for the transfer of student education records upon written request of any authorized person on behalf of an education facility operated within any correctional or health facility or, for children in the custody of the state, an education facility operated within any other state approved facility, whether within or outside the state of Louisiana, where such student has become enrolled or is seeking enrollment. The transfer of such records, whether by mail or otherwise, shall occur not later than 10 business days from the date of receipt of the written request. If the student has been expelled, the transferred records shall include the dates of the expulsion and the reason(s) for which the student was expelled.

No education record of any student may be withheld as the result of lack of payment of any fine, debt, or other outstanding obligation.

A student or his or her parent(s) may inspect the education record of that in accordance with the federal Family Education Rights and Privacy Act. Any student seeking admission to WEST JEFFERSON HIGH SCHOOL who has been suspended or expelled from any public or nonpublic school within or outside the state of Louisiana shall provide information on the dates of any suspensions or expulsions and the reason or reasons for which the student was suspended or expelled.

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Visiting Teacher/ Child Welfare and Attendance Supervisor/Families in Need of Services (FINS) Officer

It is the duty of all staff at WEST JEFFERSON HIGH SCHOOL to cooperate fully with the visiting teachers, or supervisors of child welfare and attendance. WEST JEFFERSON HIGH SCHOOL shall make available to visiting teachers, or supervisors of child welfare and attendance, FINS officers, and Truancy Assessment and Service Centers such information as will assist them in promoting the regular attendance and school adjustment of these children.

[For schools/programs housing children in state custody: It is the duty of the principals, superintendents, or heads of the training and correctional schools to notify the visiting teachers, or supervisors of child welfare and attendance, and FINS officer (if applicable) when a child is to be released and/or returned to a parish.]

Visiting teachers, or supervisors of child welfare and attendance (pursuant to R. S. 17:235), and FINS officers, shall cooperate fully with the state departments of social services, labor, and health and hospitals, and with other state and local agencies, including interchange of confidential and privileged information; cooperate fully with juvenile and family court authorities, training and correctional schools, law enforcement officers; and make such referrals and conduct such investigations as seem necessary for the enforcement of school attendance laws, including interchange of confidential and privileged information.

Statements of compliance Each homeroom teacher of students in grades 4-12 shall, on the first day of school each school year, provide information to and answer any questions from students relative to the statement of compliance as provided by JEFFERSON PARISH PUBLIC SCHOOLS BOARD.

Each parent/guardian of each student in grades 4-12 shall sign a statement of compliance committing to do all of the following: ensure that his child attends school daily, except for school absences; ensure that his child arrives at school on time each day; ensure that his child completes all required homework assignments; and attend all required parent and teacher or parent and principal conferences.

__________________________________ __________________________________ Dr. Christine Templet Larry SaveryPrincipal Assistant Principal

__________________________________ __________________________________

Leadership Team Member Leadership Team Member

__________________________________ __________________________________

Leadership Team Member Leadership Team Member

__________________________________ __________________________________

Leadership Team Member Leadership Team Member

__________________________________ __________________________________

Leadership Team Member Leadership Team Member

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__________________________________ __________________________________

Leadership Team Member Leadership Team Member

__________________________________ __________________________________

Leadership Team Member Leadership Team Member

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This worksheet and accompanying documentation should be kept on file with a copy of the School Master Plan for Discipline and the Student Handbook for purposes of review or monitoring.

A. School-Based Leadership Team Membership: (Complete Chart Below or Attach List)

Member’s Name Member’s Title Member’s Phone Member’s E-mailLarry Savery Assistant Principal 504.368.6055 [email protected]

504.368.6055504.368.6055504.368.6055504.368.6055504.368.6055504.368.6055504.368.6055

B. School-Level Data System Requirements:

Requirement Collection Tool Exists

(Yes/No) If Yes, List. If No, Suggestion(s)

Average Referrals per Day per Month Yes Infinite CampusReferrals By Problem Behavior Yes Infinite CampusReferrals by Location Yes Infinite CampusReferrals by Time Yes Infinite CampusReferrals by Student Yes Infinite CampusReferrals by Staff Yes Infinite CampusIndividual Student Report by Month and by Year

Yes Infinite Campus

Referrals by Grade Level Yes Infinite CampusOther: SummaryOther:

C. Type “Yes” or “No” in the box as applicable to the following.

1. School consistently and uniformly utilizes the two BESE-approved forms.

If no, explain:

JPPSS uses paperless referrals which contain all of the required elements.

2. School has addendum to two BESE-approved forms to assist with data collection.

If yes, attach a copy of the addendum with worksheet.

3. School has a Zero Tolerance Policy. If Yes, go to #4. If no, go to # 6.

4. Leadership Team has reviewed the Zero Tolerance Policy to ensure compliance with R.S. 17:416.15, including R.S. 17:416 (H) which prohibits disciplinary action against any pupil reasonably acting in self-defense.

No

Yes

Yes

Yes

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5. Leadership Team has revised the Zero Tolerance Policy to comply with R.S. 17:416.15.

6. Leadership Team has reviewed policies for handling suspensions and expulsions to ensure compliance with R.S. 17:416.

7. Leadership Team has reviewed procedures for handling suspensions and expulsion to ensure consistent and fair execution and to ensure that alternative interventions are used.

8. Leadership Team has reviewed policies and procedures related to referrals to Alternative Education Programs.

9. Leadership Team has reviewed the current Code of Student Conduct to ensure compliance with R.S. 17:416.12, R.S. 17:416.13 and Section 4114 of the No Child Left Behind Act of 2001.

10. Leadership Team has refined consequences to create a reward/incentives program for positive student and teacher behavior.

11. Leadership Team has created a procedure/protocol to ensure the consistent delivery of the reward/incentives program.

12. Leadership Team has defined consequences for rule violations that are clear and reasonable, that will be consistently enforced, and that will support maximum time in instruction.

13. Leadership Team has identified the clearly, defined behavioral expectations in a small set of school rules (5 or fewer).

14. Leadership Team has worked with teachers to develop lesson plans that teach these expectations across each school setting.

15. Leadership Team has worked with teachers to establish a schedule for direct instruction to be provided at the beginning of the school year and reinforced throughout the school year.

16. Leadership Team will work with the principal to develop and submit an annual report to the district’s Discipline Policy Review Committee.

17. Leadership Team has reviewed programs as required under R.S. 17:404.

18. Leadership Team has reviewed the school’s Safe and Drug Free Schools and Communities plan and the Crisis Management Plan. (Attach a copy of the Crisis Management Plan).

19. Leadership Team has developed a plan/continues to develop a plan to improve and strengthen parental and community involvement in the school, including the facilitation of partnerships with programs and organizations/agencies.(Attach a list of programs and organizations/agencies with which the school is working to strengthen family and community involvement).

20. Leadership Team has worked/continues to work with counselors, and other mental health professionals to develop a plan to identify the mental health needs of its students and to match those needs with available local resources.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

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21. Leadership Team is working to help improve communication, coordination, and collaboration between the school and agencies that serve children.

22. Leadership Team is working with the local youth planning boards to help meet the needs of all children.

23. Leadership Team has reviewed existing procedures/established procedures to ensure that records for transfer students are provided not later than 10 business days from the date of the receipt of the written request.

24. Leadership Team has reviewed existing procedures/established procedures to ensure that information on the dates and reasons for any suspension or expulsion is included on transferred student records.

25. Leadership Team has reviewed existing procedures/established procedures to ensure that all staff within the school cooperates fully with the visiting teachers/supervisor of child welfare and attendance. And Team is working with administration to ensure that all staff is aware of procedures.

26. Leadership Team has reviewed student and parent/guardian statements of compliance that must be disseminated and collected at the beginning of school each year.

27. Leadership Team is fully implementing the requirements of R.S. 17:252(D), as required by the provisions of Act 136 enacted by the 2010 Regular Session of the Louisiana Legislature, including incorporating pre-service and ongoing grade-appropriate classroom management training for teachers, principals, and other appropriate personnel regarding positive behavioral supports and reinforcement, conflict resolution, mediation, cultural competence, restorative practices, guidance and discipline, and adolescent development into the school’s master discipline plan.

28. Leadership Team is ensuring that the school affords itself the opportunity to have all applicable personnel, including classroom teachers, participate in classroom management courses required by Act 136.

Yes

Yes

Yes

Yes

Yes

Yes

Yes