This notice serves to notify___________________________________________________ Student Name ID #

that he/she has been placed on probation from _______________________________ Organization Name

on___________________ for the following reasons: Date

1. Failed to fulfill club requirements:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Violated rules set by the clubs constitution:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Violated school student code of conduct:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The student will remain on probation for_____________________ or until he/she Duration of time (dates)fulfills the requirements set forth by the club sponsor and/or administration. He/she will not be able to participate in any activities sponsored by this club until the probation is cleared.

___________________________________ Club Sponsor Date

___________________________________ Notes:Club President Date

___________________________________ Activities Director Date

iMater Academy Charter Middle/High School

Club Member Notice of Probation

iMater Form #020