JIH-EB ©

EXHIBIT

STUDENT  INTERROGATIONS,
SEARCHES,  AND  ARRESTS

FORM FOR SIGNATURE OF
ARRESTING OFFICER

I, _____________________________, a duly sworn peace officer and member of the ______________________________ Department, ________________ division, have asked that ______________________, a student in the ________________ School, be surrendered to me, and pursuant thereto have taken said student into my custody and am assuming full responsibility for the student's arrest.

Date ______________________      Signature _______________________________

Time ______________________      Badge Number  __________________________

School  Action

Date and time parents notified (if more than one [1] attempt is made, include

such information here)  __________________________________________________

_____________________________________________________________________

_________________________________________
Signature of Administrator

1 copy for School Records
1 copy for Parent Mailing
1 copy for Police Officer
1 copy for Witnessing Administrator