5145.12 Appendix A

__________ PUBLIC SCHOOLS

_____________, Connecticut

Search and Seizure

Name of the student: ________________________________ Age:_______ Sex: ___________

Parents contacted _____ YES _____ NO

Student Interrogations, Searches and Arrests

1. What factors cause you to have a reasonable suspicion that the search of this student or his or her effects, locker or automobile will turn up evidence that the student has violated or is violating the law or the rules of the school?

A. Eyewitness account:

1. By whom:__________________________________________________________________

2. Date/time:__________________________________________________________________

3. Place:_____________________________________________________________________

4. What was seen:______________________________________________________________

____________________________________________________________________________

B. Information from a reliable source.

1. From whom:________________________________________________________________

2. Time received:______________________________________________________________

3. How information was received:__________________________________________________

4. Who received the information:___________________________________________________

5. Describe information:_________________________________________________________

____________________________________________________________________________

C. Suspicious behavior. Explain:____________________________________________________

_______________________________________________________________________________

D. Time of search:_______________________________________________________________

E. Location of search:____________________________________________________________

F. Student told purpose of search:__________________________________________________

G. Consent requested:____________________________________________________________

2. Was the search you conducted reasonable in terms of scope and intrusiveness?

A. What are you searching for:______________________________________________________

B. Sex of the student:_____________________________________________________________

C. Age of the student:_____________________________________________________________

D. Exigency of the situation:_________________________________________________________

E. What type of search is being conducted:______________________________________________

F. Who is conducting the search:_____________________________________________________

Position:_____________________________________________________________________

Sex:________________________________________________________________________

G. Witness(es):__________________________________________________________________

3. Explanation of Search.

A. Describe the time and location of the search:__________________________________________

B. Describe exactly what was searched:________________________________________________

C. What did the search yield:________________________________________________________

D. What was seized:______________________________________________________________

E. Were any materials turned over to the police:__________________________________________

F. Were parents notified of the search, including the reason for it and the scope:

_______________________________________________________________________________

5145.12 Appendix A

(Alternate Form)

__________ PUBLIC SCHOOLS

_____________, Connecticut

Student Search Form

1. Name, age and sex of student:_______________________________________________

2. Time and location of search:________________________________________________

3. Basis for search and nature of reasonable suspicion. What factors caused you to have a reasonable suspicion that the search of this student, his/her person or property assigned by the District for student use, would turn up evidence of a violation of law, Board policy, administrative regulation or school rule or which possession or use of is prohibited by law, policy, regulation or rule? Explain.

________________________________________________________________________________________________

4. Describe exactly what was searched:

________________________________________________________________________________________________

5. What did the search yield? Were any prohibitive materials seized? Were seized items/materials turned over to the police? Parents? Other? Explain.

________________________________________________________________________________________________

6. Name of the witness and title/position to the search:

________________________________________________________________________________________________

7. Notifications: Parent/Guardian _____________________________________________________________________

Law Enforcement ____________________________________________________________________

Other _____________________________________________________________________________

8. Name of District official and title/position conducting the search.

________________________________________________________________________________________________