TRANSFER STUDENT DISCIPLINE INQUIRY FORM

TRANSFER STUDENT DISCIPLINE INQUIRY FORM
Student's Name*

First NameLast Name
Mother's Name*

First NameLast Name
Father's Name*

First NameLast Name
Please carefully read the pararaphs below and select the appropriate response, provide all requested information and sign this document. A willful false statement on this affirmation will result in a possible removal from Holy Family Catholic School.
PARAGRAPH 1

The undersigned affirms that the student HAS NOT BEEN suspended or expelled from any public or private school in Michigan or any other state for an offense involving weapons, alcohol, drugs, or the willful infliction of injury to another person or for any act of violence against persons and/or property committed on school or school property or during a school sponsored activity.
PARAGRAPH 2

The undersigned affirms that the student HAS BEEN suspended or expelled from a public or private school in Michigan or another state for an offense involving weapons, alcohol. drugs, or for the willful infliction of injury to another person or for an act of violence against persons and/or property committed on school premises, at a school-related activity or on a conveyance providing transportation to and from a school-sponsored activity.
Please choose one of the following:*

Paragraph 1Paragraph 2
If you selected Paragraph 2, please explain the circumstances/give a description of the incident below. I
Explanation of suspension/expulsion:
Name of school previously attended:
Address of school previously attended:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your signatures below grant Holy Family School permission to contact the above school to verify the information provided above is correct.
Student Signature*

Clear
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: