# JICK-E3 - Bullying: Summary of Disciplinary and Remedial Actions

**JICK-E3 - Bullying: Summary of Disciplinary and Remedial Actions**<span class="Apple-converted-space"> </span>

This page is for use when a **substantiated** incident of bullying is entered into the Report of Substantiated Incident of Bullying in the Maine Department of Education’s NEO data reporting system. It is aligned with the NEO data categories.*<span class="Apple-converted-space"> </span>*

This documentation is in reference to the alleged incident of bullying reported on:

\[<span style="text-decoration: underline;"><span class="s1">Date of incident</span></span>\]

Name of student who was found to have bullied \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **(name is for tracking in school unit files only; do not report name of student or any personally identifying information to the Maine Department of Education)**<span class="Apple-converted-space"> </span>

Delineate the specific nature(s) of the incident:

\_\_\_\_\_ Cyberbullying

\_\_\_\_\_ Electronic expression

\_\_\_\_\_ Physical act or gesture

\_\_\_\_\_ Retaliation

\_\_\_\_\_ Verbal/Oral

\_\_\_\_\_ Written

Alternative discipline imposed for this student (actions taken):

\_\_\_\_\_ Meeting with the student and the student's parent(s) or guardian(s)

\_\_\_\_\_ Reflective activities, such as requiring the student to write an essay about the student's misbehavior

\_\_\_\_\_ Mediation, but only when there is mutual conflict between peers, rather than one-way negative behavior, and both parties voluntarily choose this option

\_\_\_\_\_ Counseling

\_\_\_\_\_ Anger management

\_\_\_\_\_ Health counseling or intervention

\_\_\_\_\_ Mental health counseling

\_\_\_\_\_ Participation in skills building and resolution activities, such as social/ emotional/ cognitive skills building, resolution circles and restorative conferencing

\_\_\_\_\_ Community service

The student received/will receive the following discipline actions (consequences):

\_\_\_\_\_ Alternative Discipline

\_\_\_\_\_ Detention

\_\_\_\_\_ Weekend Detention

\_\_\_\_\_ In-school suspension

\_\_\_\_\_ Out-of-school suspension

\_\_\_\_\_ Expulsion/Recommended for expulsion

The following serves as a record that a report of substantiated bullying has been submitted to the Maine Department of Education.<span class="Apple-converted-space"> </span>

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ <span class="Apple-converted-space"> </span>Date: \_\_\_\_\_\_\_\_\_\_\_\_\_

Signature and position of person completing this form

Data reported to Maine DOE (NEO) on \[<span class="s1">Date</span>\] by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature, Position of Reporter<span class="Apple-converted-space"> </span>

<span class="Apple-converted-space"> </span>

Copy to building principal on \[<span class="s1">Date</span>\]<span class="Apple-converted-space"> </span>

Copy to Superintendent on \[<span class="s1">Date</span>\]

Cross Reference: ACAA-R – Student Harassment and Sexual Harassment Procedure

JICK – Bullying

JICK-R - Bullying-Administrative Procedure

JRA-R – Student Education Records and Student Information

**<span class="Apple-converted-space"> </span>**

Policy Adopted: November 1, 2006

Policy Revised: May 15, 2013, March 01, 2017

Policy/Exhibit Reviewed: January 20, 2021