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Student Behavior Referral Today’s date Student Name
Grade
9
Staff Member Name Category of Behavior (choose from drop down menu)
Academic Dishonesty
Date and Description of Event
Teacher Consequence
Administrator Name Administrator Consequence
1095 Lake Cook Road
Deerfield, IL 60015
Phone: 847.470.6700
Fax: 847.324.3701
www.cjhs.org
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