YELLOWSTONE
COUNTY SHERIFF'S OFFICE
School Faculty Prohibited Substance Violation Complaint
Name
of Student/Suspect ______________________________ Age _____
Description
of DescrStudent/Suspect_______________________________
_____________________________________________________________
Date,
Time and Location of Violation_______________________________
_____________________________________________________________
Statement of Circumstances:
Please give a detailed account of the violation including
names of any other present or witnessing the violation and
any statements made by student/suspect.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
What type of substance, alcohol, illegal drugs, cigarettes,
etc. was the student using?____________________________________________________________
Was evidence seized and marked? Yes ____ No ____
If
you answered "Yes" to the above question, list
evidence seized and marked. _________________________________________________________________
_________________________________________________________________
Faculty member making report: _______________________________________
School
Name _______________________________________
Address ____________________________________________
School
Phone__________________________
YELLOWSTONE COUNTY SHERIFF'S OFFICE
School Faculty Illegal Substance Violation Complaint
(Continued from page 1 of form)
Was
Sheriffís Office notified: (by phone) Yes___
No ___
(form sent) Yes___ No ___
Was
copy sent to studentís parents/guardian? Yes___
No___
Student Signature: ____________________________________________________________
(Signature indicates student has read this report.)
Student Response
_____
Yes, I admit to violating state law and school polity by
using or
possessing an illegal substance.
_____
I deny violating state law and school policy by using or possessing
an illegal substance.
Comments:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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