Benson Middle School

2019-2020
Name:__________________________________ Date:_________________________

Statement:

Administration: Reference to:

Result if applicable:
 Benson Middle School
2019-2020
Student Name :________________________________ Date:_____________________________
Parent Name:_________________________________ Contact:___________________________

Statement/Concern:

Administration: Reference to:

Result if applicable:
 Benson Middle School
2019-2020 Checklist
Name:___________________________________ Date:_________________________
Incident__________________________________

OSS Checklist Steps:

1. ​Complete Benson Middle Referral Form

○ BMS Referral
○ Make sure to note administrative action.
○ Make 3 Copies (Parent, Folder, Personal Files)

2. ​ Complete Powerschool Incident Report

○ Powerschool
○ Print 3 Copies (Parent, Folder, Personal Files)

3. ​ omplete Johnston County Schools Suspension Form

C
○ Johnston County Public Schools Code of Student Conduct Notice of Suspension Form
○ Print 3 Copies (Parent, Folder, Personal Files)
○ Check to see if the student is EC and has over 10 days OSS
■ If no continue to next step
■ If Yes schedule MDT with case manager and complete on form

4. ​For any student over 3 days OSS send home the following form
○ Structured Day Program

Administration: Reference to:

Notes if Applicable: