ACT Central Texas High School

4102 S. 31st. Suite # 400

Temple, Texas 76502
Student Name:
Parent or Guardian Name(s):
Phone Number:
Email Address:
Home Address:
Date and Time of Contact:
____ Phone call.
____ E-mail.
____ Letter.
____ Detention Notice.
____ Home Visit.
____ Informal Meeting.
____ Meeting with an Administrator.
____ Meeting with a Counselor.
____ Parent Teacher Conference.
____ Other Type of Contact.
Person Initiating Contact:___________________________________________________________________.
People Present t the Meeting, Conference or Contact Event:____________________________
_______________________________________________________________________________________________ .
Topics Discussed:___________________________________________________________________________.
Steps Parent(s) or Guardian will take:_____________________________________________________
________________________________________________________________________________________________.
Steps Teacher will Take: ___________________________________________________________________.
Additional Notes and Reflections: _________________________________________________________
________________________________________________________________________________________________.

Rene Rodriguez
Spanish Teacher
ACT Central Texas High School