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

JICK-E3 - Bullying: Summary of Disciplinary and Remedial Actions   
 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.   
 This documentation is in reference to the alleged incident of bullying reported on: 
 [ Date of incident ] 
 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)   
 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.   
 ___________________________________________             Date: _____________ 
 Signature and position of person completing this form 
 
 Data reported to Maine DOE (NEO) on [ Date ] by _________________________________ 
 Signature, Position of Reporter                             
                                                                     
 Copy to building principal on [ Date ]   
 Copy to Superintendent on [ Date ] 
 
 
 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 
   
 Policy Adopted: November 1, 2006 
 Policy Revised: May 15, 2013, March 01, 2017 
 Policy/Exhibit Reviewed: January 20, 2021