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					Newark Public Schools                                                         Office of Extended School Day Programs
                                                                                                               Form 119

                             After School Youth Development Program

                                       Request for Formal Parent Conference

Dear Parent/Guardian:
This letter is to inform you that your child _______________________________ has behaved in a

manner that is unacceptable in the After School Youth Development Program. As a result, you must

attend a conference with the program monitor and site teacher. This conference is requested because

your child has demonstrated the following inappropriate behavior(s) that is in violation of the Student

Discipline Policy:

    ____      Threatens students                 ____      Smoking                   ____ Fighting
    ____      Disrespectful to staff             ____      Vandalism                 ____ Stealing
    ____      Use of profanity                   ____      Erratic behavior          ____ Disrupts class
    ____      Does not follow rules               Other:
    Date of Infraction(s):                  Teacher Follow-up:

All participants in the ASYDP are expected to conduct themselves in a manner that is conducive
    to safety and positive interaction at all times. The ASYDP implements the Newark Public
                                         Schools Discipline Policy Code.

Please arrange to attend the conference on _________________ at ______ a.m./p.m. If you cannot
keep this appointment, please call (         ) ___________________ immediately to reschedule. If you do
not respond to this request, your child automatically advances to Level III of the Student Discipline
Policy, which is suspension. If this matter is not resolved, your child may be considered for dismissal
from the program. Attached is a copy of the Student Discipline Policy.

ASYDP Instructor: _______________________________                        Date:___________________

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