Action Plan

Name: _________________________ Date:___________

Parents, this is a plan your child and I have made regarding your childs behavior. Please
read through this and SIGN THE BACK. Thank you.
What happened?

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Why did I do what I did?

Why did I do what I did?

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How will I do better next time?

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 Action Plan
Name: _________________________ Date:___________

The consequence for my actions is

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I received/will receive my consequence: _______________________

Notes from the teacher:

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Teacher: I have read the Action Plan and discussed it with the student. I agree with this plan.

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(Teacher Signature)

Student: I agree to the consequence above and I will try use this plan to do better next time

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(Student Signature)

Parent: I have read the plan and I will call or email Miss Ditzhazy if I have any questions.

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(Parent Signature)