Exit Committee Report

Yoakum ISD Exit Committee Report

Date: _______________ 

Student name: ______________________ Campus: _____________________

Grade level: ______   Person initiating request: __________________________

List previous classroom/campus interventions for student:

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Committee Decision

_____ Exit granted         ____ Exit denied         ____Additional Intervention(s)

Rationale for exit or denial: __________________________________________

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Committee Members

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Student

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Parent(s)/Guardian(s)

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Teacher(s)

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Principal/Counselor

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Other (specify)

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Other (specify)