Behavior Referral Form (or Office Discipline Referral form)

At this stage the team's purpose is to develop an efficient and effective discipline data gathering tool that provides key, relevant information in a format easily summarized and presented. An effective behavior referral form will

• be easy and quick to fill out
• ask for the right information
• be viewed by staff as an important data collection tool.

In addition to identifying information such as

• student name
• referring staff name
• grade level
• date and time,

the referral form should include sections relating to

• location
• problem behavior
• possible motivation (function of behavior, to get or avoid something)
• others involved
• any administrative decision, and
• a brief comments section.

Some of these referral forms include a parental signature (which can be optional or required) while others include space to record the follow-up conversation with a student.

If your school or facility is using SWIS, the order in which major and minor problem behaviors are listed on the form should mirror the order in which they appear on the SWIS data entry screen. This facilitates easy and more accurate data entry of office referrals.

Once the behavior referral form has been finalized, keep in mind that staff will need practice and periodic troubleshooting about the proper completion of the form. In general, time should be set aside for faculty and staff to address questions about completing the form as certain issues arise. Some of the more common issues or concerns include

• the faculty's comfort in assessing student motivation
• how to complete the form if more than one behavior occurs simultaneously
• whether minors are reported, and if so how
• providing effective parent communication around problem behavior and
• an understanding of what administrative decisions are made in response to problem behavior and the follow-up that can be expected.

Faculty, staff and volunteers should be given positive feedback for using the form as well as corrective guidance early on if their use of the form is inconsistent or inaccurate.

Office Referral Form Examples