Student Referral and Information Form Elective Course Semester Teacher Packet Teacher Date Received Completed Signature (Yes/No) Student Name: ID: 0 Grade Level: Home Campus: Referring Administrator: Phone: Parent/Guardian Name: Street Address: Zip: 799XX Phone: This student is referred to KEYS Academy in accordance with the following Socorro ISD Student Code of Conduct discipline infraction (Please have parent/guardian initial on the corresponding blank lines). A: Level 3 Discretionary Placement P/G Initials _______. (9 school week placement depending on offense). P/G Initials ______ B: Level 3 Mandatory Placement (9 school week placement).
Elective Course Semester Teacher Packet Completed (Yes/No) Teacher Signature Date Received Student Referral and Information Form Student Name: ID: 0 Grade Level: Home Campus: Referring Administrator: Phone: Parent/Guardian Name: Street Address: Zip: 799XX Phone: This student is referred to KEYS Academy in accordance with the following Socorro ISD Student Code of Conduct discipline infraction (Please have parent/guardian initial on the corresponding blank lines). A: Level 3 Discretionary Placement P/G Initials _______. (9 school week placement depending on offense). B: Level 3 Mandatory Placement P/G Initials ______ (9 school week placement).
2017-18%20DAEP%20KEYS%20Academy%20Intake%20Packet.docx