Ethnicity *
Foster Child *
Does the student speak a language other than English? *
Has this student ever been suspended or expelled from a school? *
I hereby certify and represent to the School District of Webster Groves, for the purposes of the
Missouri Safe Schools Act, that:
This student has not been convicted or indicted of any of the following offenses, and no information or petition alleging such offense has been filed:
a. first-degree murder under Section 565.020, RSMo.
b. second-degree murder under Section 565.021, RSMo.
c. first-degree assault under Section 565.050, RSMo.
d. forcible rape under Section 566.030, RSMo.
e. forcible sodomy under Section 566.060, RSMo.
f. robbery in the first degree under Section 569.020, RSMo.
g. distribution of drugs to a minor under Section 195.212, RSMo.
h. arson in the first degree under Section 569.040, RSMo.
i. kidnapping, when classified as a Class A felony, under Section 565.100, RSMo. *

Are there any court order documents currently in effect for this student? *

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