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Staffs lnitial
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student first & last name

Grade Team

From:

staff member initials

Date:
DroD off ticket in qrade-level mailbox bv office
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 I-school
Daily Progress Repoft (DPR)

Name: Grade: Today's Date:

Class Be a Productive Total

Class & Teacher Initials Be Safe Be Respectful Be Responsible
Period Learner Points
1 0 1 2 0 1 2 0 1 2 0 1 2

2 0 1 2 0 1 2 0 1 2 0 1 2

3 0 1 2 0 1 2 0 1 2 0 1 2

RTI 0 1 2 0 1 2 0 1 2 0 1 2

4 0 I 2 0 1 2 0 1 2 0 1 2

5 0 1 2 0 1 2 0 1 2 0 I 2

6 0 1 2 0 1 2 0 1 2 0 1 2

7 0 1 2 0 1 2 0 1 2 o 1 2

Today's Total Points = I 64

Your daily goal is B0%o or better. Did you reach your daily goal today?

^d(eyrnorrpu M PRE EXCUSE

Date {ltudent,e Hame r- Time In

m WtU lo absent
t Har been absent for ths tollowing houre/days due to:
fJ Illnecs n DentallOrtho
E Persona{Parent Rcque$t n Funeral
U $uesenrlon n Sportt
ff Sther
InItiaIcr
 RECOVERY REFLECTTON FORM Ir
You ore welcome to be with us for every good
minute-this meons every minute you ore not moking it
teach or for others to le.orn' tJse this "Recovery" time difficult for me to
to get yoursetf bock togetier. we wont you in the classroom,
complete this form ond return so
iust os soon os yo, xnowTnit you ,o, ni nri *,i"rr'i"iir'ring onyone
else.

Name:
Date: Class Period:

Whose classroom did you come from?

whichfexpectation did you choose not to fo[ow? (please circle)

Be sofe Be responsible Be respectful

What was it that you wanted? (please check appropriate

box)

! I wanted attention from my classmate(s).

E I wanted attention from adult(s).
I I wanted to avoid classmate(s).
! I wanted to avoid adult(s).
I I wanted to avoid work/activity.
I I wanted to obtain item/activities.

Explain why you wanted this:

Explain how your actions affected

what will you do differently next time? (complete the

sentence starter below, and be specific.)

Next time, I will...

Student signature:

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To be completed by aetaff member.

Referring staff member: Date: Class Period:

Persons involved: I None (only the student] f Peers ! Teacher E Staff f Substitute f, Unknown

Did you send student to Recovery? [ Yes E No

Problem behavior: (Check l-2 behaviors as applicable; circle the primary behavior.)
! Horseplay and play fighting I lnappropriate physical contact with another person
(lnvolves no intent to horm') (tntentionolly touching or moking physical contoct with another
i ndivi d uol without that i nd ivi du o l's per mi ssion.)

I Failure to follow instructions I Leaving class without permission ffiffi,

I lnappropriate language ! Teasing and name-calling

(Not directed ot o specific person.) (lntended to merely distroct or onnoy others. Bullying, harossment,
hozing, ond discrimination ore Level ll offenses.)

I Misuse of property ! Misuse of technology

(Uses property without permission or in a woy that's inconsrstenf (Doesn't result in horm or potentiol horm to the student, onother
withthe intended use of the property.) ,:ili,illi,;i[E]"#il*i,o*,orot's property. tJsed to ensose in

E Dress code violation ! Cheating and plagiarism

I Tardiness I Dishonesty
(Not telling the truth or providing informotion that is misleoding.)

Staff member's statement:

Didyou contactstudent's parent/guardian? Iyes n No

o what method of contact did you use?: I Email ! phone call f In-person

Did you meet with the student individuatty afterwards to re-teach behavioral expectations? E yes n No
ls the student's behavior becoming a repetitive pattern in your classroom? f yes tr No
eYr**tilr,*,.+*rgl t_evelr-ffiI