Consequences (Behavior Plan)

First Verbal
Warning

Second Verbal
Warning and
Documentation

Third Warning,
Action Plan,
and Parental
Contact

Disciplinary
Referral

First Warning

Verbal Warning

Second Warning

Verbal Warning
Guideline Infraction Notice
o See Attached

Third Warning

Verbal Warning
o See Attached
Action Plan
Parental Contact
o See Attached Log

Positive Behavior Rewards

Smile

Positive
Comment
(Verbal or
Written)

Positive
Note Home

Guideline Infraction Notice

See Me After Class!
Offense: ____________________________________________
___________________________________________________
Teacher Signature: ____________________________________
Student Signature: ____________________________________
Date: _______________________________________________

Guideline Infraction Notice

See Me After Class!
Offense: ____________________________________________
___________________________________________________
Teacher Signature: ____________________________________
Student Signature: ____________________________________
Date: _______________________________________________

Ms. Starkweathers Behavior Action Plan

Student Name: _________________________________________________________ Period: _____________________
Teacher Explanation of Problem:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________

Student Explanation of Reasoning behind Actions:

_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________

Teacher Signature: _____________________________________________________ Date: ________________________

Student Signature: _____________________________________________________ Date: ________________________

Parent Contact Log

Date

Student

Phone or Email Used

Notes