TEACHER DISCUSSION and BEHAVIOR CONTRACT

I, (NAME) _____________________________________, am being asked to participate in a

teacher discussion and complete a behavior contract for the following reason(s):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Moving forward, I promise to stop the above behavior(s).
By initialing, I acknowledge that I understand that if I chose to continue the above behaviors it
may result in a call home, teachers detention, and/or deans referral. (Initial) ____________
By initialing, I acknowledge that I understand Ms. Rodriguezs class rule We agree to be
considerate and responsible students at all times and I agree to always abide by it. (Initial)
_________________
By initialing, I acknowledge that I am aware of the progressive discipline plan; that I have been
given verbal warnings (STEP 1), and am now on STEP 2: Teacher Discussion and Behavior
Contract. (Initial) ____________
Some solutions to help me avoid this negative behavior in the future are:
1. ___________________________________________________________________
2. ___________________________________________________________________
3. ___________________________________________________________________
Please remember that this rule is in place FOR YOU so that you and every other student can feel
comfortable and are able to learn in a positive environment. Your teacher has NO TOLERANCE
for distractions, interruptions, or rudeness of any kind during instruction. (Initial) ___________
TEACHER SIGNATURE ________________________________

DATE _____________

STUDENT SIGNATURE _________________________________

DATE ____________