Instructions: Fill out the online strike report, get it signed, and Upload the Strike Report to the JCS Staff Portal/Student Information. 
If this is the student’s third strike, a Drop/Withdrawal Form and progress report or report card MUST accompany the strike report.


Student Name
	JCS Student Number
	Grade Level
	Date
	

	

	

	

	Teacher of Record (EF/Advisor) Name
	Teacher of Record Number
	Strike Date
	Start
End
	

	

	

Reason for Strike Report:
☐ Failure to complete at least 80% of assignments or specialist assignments


☐ 
☐        
	Strike Number:
☐        ☐ 1  (Strike Report will be submitted to Main Office and recorded in this     student’s records.)
☐        ☐ 2  (Official Warning Letter will be sent to family regarding this student.)
☐        ☐ 3  A (5) day notice will be given to all parents prior to the (Notice of Withdrawal for this student will be sent to family.)
	

Strike #
	Strike Date
	Comment
	Action Plan
	Strike 1 Date
	

	

	

	Strike 2 Date
	

	

	

	Strike 3 Date:


	

	

	

	☐  EF (we should add teacher/coordinator) recommends that Independent Study is not an appropriate placement for this student in the future. 
☐  Student withdrawal is pending review
	

Invited Meeting Participants
	Signatures: (EF/Advisor: initial next to any missing party. EF may note N/A next to “Other.”)
	☐
	____  EF/Advisor: ________________________________________   Date: ________
	☐   
	____  Parent/Legal Guardian:_______________________________    Date: ________        
	☐
	____  Student:___________________________________________   Date: ________        
	☐
	____  Other School Representative: __________________________  Date: ________        
	☐
	____  Other: _____________________________________________ Date: ________        
	cc: Principal 
JCS, Inc. Adequate Progress/Strike                Page  of 4