(Date)
(Name of Parent/Person in Parental Relation)
(Address of Parent/Person in Parental Relation)
Dear (Parent/Person in Parental Relation Name):
As we notified you on (date) via (method of communication), (student’s name) engaged in the following behavior: (description of behavior precipitating the use of timeout or physical restraint) on (date).
We attempted the following behavior support strategies: (description of positive, proactive strategies, less restrictive and intrusive interventions, and de-escalation techniques used prior to timeout or restraint use).
When these attempts did not succeed, we [select one: [(A) sent (student’s name) to the space used for timeout (or insert name used by the school) (B) physically restrained (student’s name)] for a period of (number) minutes.
We invite you to meet with us to discuss this incident. Please contact me at (contact information) to schedule a time. We have also included a copy of the documentation of the incident, as well as the district’s policy and regulation on timeout and restraint.
Please contact (name and contact information) if you have any questions or need any additional information.
Sincerely,
(Name, Title)
Adoption date: January 8, 2024