JIH-EC ©

EXHIBIT

STUDENT  INTERROGATIONS, 
SEARCHES,  AND  ARRESTS

FORM FOR SIGNATURE OF
INTERVIEWING OFFICER

I, _______________________________________, a duly sworn peace officer and member of the _____________________________________________ Department, _____________________ division, have asked that _________________________, a student in the ________________________________________________________ School, be made available for interview.

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