Spring 2017

Learning Choice
Middle School
Name: ___________________________ Class Period: _____ Time: ______________

Learning Choice:
3rd Nine Weeks

Electronic Device
1. Warning __________________________________________ Initial_____
2. ISS (Student Pick-Up)__________________________________________ Initial_____
3. ISS (Parent Pick-Up) __________________________________________ Initial_____
4. ISS (Parent conference) ______________________________________ Initial_____

KTardies

1. Warning __________________________________________ Initial____

2. 2. 30 min det. & p. conf. __________________________________________ Initial_____
3. 1 hour det. & p. conf. _________________________________________ Initial_____
4. Office Referral __________________________________________ Initial_____

D Disruptive behavior
1. Warning __________________________________________ Initial_____
2. S/T Conf. __________________________________________ Initial_____
3. 30 min det. & p. conf. __________________________________________ Initial_____
4. 1 hour det. & p. conf. ______________________________________ Initial_____
5. Office Referral __________________________________________ Initial_____

Restroom Breaks
1. Pass __________________________________________ Initial_____
2. Pass warning more __________________________________________ Initial_____
3. Pass Last One __________________________________________ Initial_____
4. Emergency Pass ______________________________________ Initial_____
5. Parent contact __________________________________________ Initial_____

_____________________ ___________
Student Signature Date

_____________________ ___________
Teacher Signature Date
Spring 2017
Means of Contact: Phone E-mail In person After Class
Spoke with: _________________________ Date: ______________ Time: ________
WK Phone: _______________________ HM Phone: ___________________
Cell Phone: _______________________ E-mail: _______________________
What was discussed & Actions to be taken: ________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Means of Contact: Phone E-mail In person After Class

Spoke with: _________________________ Date: ______________ Time: ________
WK Phone: _______________________ HM Phone: ___________________
Cell Phone: _______________________ E-mail: _______________________
What was discussed & Actions to be taken: ________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Means of Contact: Phone E-mail In person After Class

Spoke with: _________________________ Date: ______________ Time: ________
WK Phone: _______________________ HM Phone: ___________________
Cell Phone: _______________________ E-mail: _______________________
What was discussed & Actions to be taken: ________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Means of Contact: Phone E-mail In person After Class

Spoke with: _________________________ Date: ______________ Time: ________
WK Phone: _______________________ HM Phone: ___________________
Cell Phone: _______________________ E-mail: _______________________
What was discussed & Actions to be taken: ________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Means of Contact: Phone E-mail In person After Class

Spoke with: _________________________ Date: ______________ Time: ________
WK Phone: _______________________ HM Phone: ___________________
Cell Phone: _______________________ E-mail: _______________________
What was discussed & Actions to be taken: ________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Additional Notes: