Code:   JHFDA-AR(1)

                                                                                                                                           Adopted:  

                             Request for a Suspended Driving Privilege - Conduct

 

Name of Student                                                                                                                          

 

Address of Student                                                                                                                       

 

Date of Birth                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             ODL Number (if applicable)                                                                                                                                                    

 

Number of requests for suspension on this student: G one G two or more

 

Type of privilege requested for suspension:

 

G      Driving privilege

G      Application for driving privilege

 

Length of suspension requested:

 

G      No more than one year

G      Six months

G      Six weeks

G      Other

 

If two or more requests for suspension have been made on this student:

 

G      [Two years]

G      [         ]

G      Until student is 21 years of age

 

[Type of infraction:

 

G      Expelled for bringing a weapon on school property.

G      Suspended or expelled at least twice for assaulting or menacing a school employee or another student, for willful damage or injury to district property or for use of threats, intimidation, harassment or coercion against a district employee or another student, possessing, using or delivering a controlled substance or being under the influence of a controlled substance at a school or on school property or at a school-sponsored activity, function or event.]

 

This written request is submitted on                                  by:

 

Name:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Title:                                                                        

 

District:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Date:                                                                        

2/1/04*NC