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Document of Artifacts: ELCC Standard 5.

0 Ethical Leadership

Description of Artifact

In the fall of 2017, the principal and I realized that there was not a consistent

method for documenting students’ statements after incidents occurred. In order to rectify this

situation, I created a student statement form that could be used by victims, witnesses and

aggressors. The statement form can be filled out by the student, or a scribe can take notes after

asking the student the questions on the form. This process allows for all students involved in

incidents to have the same questions asked.

Alignment to ELCC 5.0 Ethical Leadership

Creating and then consistently using a student statement form helps to ensure integrity,

fairness and accountability in the student discipline process (ELCC 5.1). When the principal and

I reflected and realized that we did not have a consistent way that we were documenting student

statements after discipline infractions, we rectified the situation and changed our practice (ELCC

5.2). Consistently using the statement form ensured all of the students involved in incidents had

an opportunity to tell their side of the story which is an important component of due process

(ELCC 5.3, 5.4). The student statement form has a place for students to tell how they felt about

the incident and why they think the incident occurred. This information allowed us to know how

students felt about a specific incident which allowed to have a better understanding of the

incident and we were able to respond, take action, provide instruction and assign consequences

accordingly (ELCC 5.5).

Significance

As an educational leader, it is important for me to act in an ethical and legal manner.

When it comes to student discipline, it is paramount to follow appropriate legal and ethical
procedures. Creating and then consistently using a student statement form is one way that I can

demonstrate fair and equitable treatment of students in the student discipline process.
Student Statement Form
Complete this form, giving as much honest and truthful information as possible. The
information will be used to help the administrators sort out the problem.

Name ____________________________________Grade________ Date_____________

WHO was involved? List any witnesses.

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

WHEN did the incident take place? Give as close to exact time(s) and date(s) as possible.

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

WHERE did this happen?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

WHAT actually happened? Give details beginning with how it got started. Who said
what?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
How did this make you feel?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

WHY do you think this happened?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

I certify that the above information is TRUE and CORRECT.

Student's Signature

Scribe’s Signature