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ALLEN, Andrew Parker
Grade 9 : Rydell High School
SSID : 101758
Save Behavior Report
SS Case #78550
06/24/2020 08:30
Presenting Issue : Pregnancy / Suspected Pregnancy - Child Abuse / Suspected Child
STUDENT
ALLEN, Andrew Parker
Grade 9, Rydell High
HR TEACHER Lindsay Acosta, Teacher
STUDENT ADDRESS 123, Sloan Lane, Athens, AL - 35611.
PHONE NUMBER 123-456-7890
SSN 123456789
DATE OF BIRTH 12/22/2005
AGE 15
GENDER F
RACE W
MEDICARE NUMBER
PARENT/GUARDIAN NAME Will Parker, Sarah Parker
PHONE 123-456-7890
CONCERNS Other students reported that the student said she was pregnant. Other observations were made to suspect possible abuse.
BY Lindsay Acosta
Response
06/24/2020 09:06
BY Lindsay Acosta , Teacher
ACTIONS
Phone Call : 09/20/2019
Mailed Letter : 09/22/2020
Print Referral Submit Referral
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Case # Student Name Presenting Issue Summary Last Updat Date Direct Services Comments
45 Allen, Andrew Parker In-Class Behavior Student's in class behavior has suddenly changed. 10/01/2019 Classroom Observation Student Interview Contact Parent/Guardian Student's parents are frequently flighting and causing problems at home.
Conduct a threat assessment for a student who may pose a threat to themselves, others, or school property
Initiate and track a threat assessment for a threatening incident or concerning behavior.
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Case # Threat Level Threat To Student Summary Reported by Reported Witnesses Status
12 High Harm to Self JOHNSON, Samantha Student stated she wanted to "Hurt herself" MGee, Greta 04/22/2020
Joe Smith
Sarah Jones
 Assessing
Student Behavior Reports - Current School Year
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Report # Report Description Student Name Grade School Description Updated By Updated On
78550 Figting Harassment ALLEN, Andrew Parker
9
 Bristol Elem Evan Pretended to chock another student out of anger Lindsay Acosta 11/15/2019 08:28
58969 General Misconduct ALLEN, Andrew Parker
9
 Bristol Elem Arguing Tammi England
58758 Figting Harassment ALLEN, Andrew Parker
9
 Bristol Elem Instigating a fight between Lamisha and Kourtney in P.E. Stefanie Barr 05/17/2019 14:08
Behavior
Attendance
Grades
Behavior Summary
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Session Discipline Report Positive Report
2017-2018 Rydell High School 19 (17 ODR) 2
Alerts
Schedule and Activities
Period Course Teacher
1 German 1 Acosta, Vera
1 World History : 1500-PresentHGr9 Buck, Joel
2 Algebra 1 Day, willie
2 Prin Biomedical Sciences-PLTW Justice, Chrysantha
Power Hour HmroomGr6-12 Melendez, Macie
Student
Email andrew.allen@example.com
Phone (Primary) 256-555-1017
Address #25, Green Street, USA
Mother : Jennifer Allen
Custodian
Emergency Contact
Family Member
Email jennifer.allen@example.com
Phone # (Primary) 256-555-1017
Phone # (Cell) 256-555-8307
Phone # (Work) 256-555-4225 (Ext. 754)
Address #25, Green Street, USA
Father : Jason Allen
Custodian
Emergency Contact
Family Member
Email jason.allen@example.com
Phone # (Primary) 256-555-1017
Phone # (Cell) 256-555-8111
Phone # (Work) 256-555-9644
Address #25, Green Street, USA
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SECTION I – CHILDREN ALLEGEDLY ABUSED OR NEGLECTED
Sr. No. Full Name Gender ETHNICITY DOB
1
2
3
4
5
Street Address
City
State
ZIP
Telephone
SECTION II – OTHER PERSONS LIVING WITH THE CHILDREN
(Include parents/custodians and other children in the home)
Sr. No. Full Name DOB ETHNICITY Relationship to the Children
1
2
3
4
5
SECTION III – PERSON(S) ALLEGEDLY RESPONSIBLE FOR THE ABUSE OR NEGLECT
Name
Gender
Ethnicity
BOD
Street Address
City
State
ZIP
Telephone
Name
Gender
Ethnicity
BOD
Street Address
City
State
ZIP
Telephone
SECTION IV – ABUSE OR NEGLECT ALLEGATIONS
(Describe what happened, how it affected the children, and the date(s) occurred, if known.)
Sr. No. Full Name DOB ETHNICITY Relationship to the Children
1
2
3
4
5
SECTION V - OTHER PERTINENT INFORMATION
SECTION VI - REPORTER
Name
Address
Telephone Number
Title / Agency / Relationship to Children
Did you verbally report the allegations to the Department of Human Resources or law enforcement?
FOR DHR USE ONLY
Country
Case #
Date