5131.911 Form 3 5131.911 Form 3Response Process(es) Notification Form
The purpose of this form is to provide a template for transparency and accountability to a person(s) that submit(s) a report of challenging behavior.
The school climate specialist will complete and submit this form within three (3) school business days after an assessment has been finalized and submit it to the student(s), parent(s), or guardian(s), and/or school employee(s) who completed the "Challenging Behavior Reporting Form".
Describe the steps taken to address and prevent future instance(s) of challenging behavior(s). Responses may include:
• utilization of restorative practices;
• the completion of a school-based threat assessment;
• safety plan for student(s) involved in the instance of alleged challenging behavior;
• student support services;
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Signature or E-signature of school climate specialist: __________________________________________
Printed name: ________________________________________________________________________
Date completed: _____________________________
Definitions and Clarifying Terms
Restorative Practices: Evidence and research-based system-level practices that focus on (A) building high-quality, constructive relationships among the school community, (B) holding each student accountable for any challenging behavior, and (C) ensuring each such student has a role in repairing relationships and reintegrating into the school community.
School Based Threat Assessment: An evidence-based systematic evaluation process used to prevent violence, help troubled students, and avoid over-reactions to challenging behavior.