Fill and Sign the Notice to School Board Form

JD-1725 , 05/14 Notice to School Board §§48.355(2)(c) and 938.396(2g)(m), W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use IN THE INTEREST OF Name Notice to School Board Date of Birth Case No. To: This is to notify you that 1. A petition has been filed alleging the juvenile has committed a delinquent act that would be a felony if committed by an adult . The nature of the delinquent act alleged is: 2. The juvenile has been adjudicated delinquent. This was was not a delinquent act committed at the reques t of or for the benefit of a criminal gang and would have been a felony if committed by an adult. A copy of the dispositional order, which identifies the nature of the vi olation, is attached or will be provided to you upon signing by the court. 3. The court has ordered the child/ juvenile to attend school as a condition of the dispositional order. If the child/ juvenile violates this school attendance r equirement, you are required to notify the county department responsible for supervising the child/ juvenile of that violation within five days after the violation. The county department that is responsible for supervising the child/ juvenile is: 4. As a result of the dispositional order in this case, the juvenile is enrolled in your school district. This district is different from the district in which the juvenile was enrolled at the time of disposition. Attached are copies of the dispositional order(s) in any other case(s) for which the juvenile was adjudicated delinquent in this court. The juvenile has not previously been adjudicated delinquent in this court. 5. The juvenile delinquency petition has been dismissed. The uses and redisclosure of this information by the school dist rict is limited under § §48.396(1) and 938.396(2g)(m ), Wis. Stats.: • The information can only be disclosed to employees who work directly with the child/ juvenile or who have legitimate educational interests, including safety interests in the information. • A district employee may not further disclose the information. • A school board may not use the information as the sole basis for expulsion or suspension of the child/ juvenile . DISTRIBUTION: 1. Original - Court 2. Copy to School Board Signature of Court Clerk Name Printed or Typed Date