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STUDENT IN DANGER OF FAILING FORM
There are 5 people who should never be surprised of a student failing; the teacher, the student, the parent and the administrators.
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Email
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Your email
Teacher Completing Failure Form:
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Choose
Bain, Amber
Bigott, Samuel
Bonam, Melanie
Bordovsky, Emily
Cannon, Will
Critt, Paige
Dalton, Mary
Dixon, George
Foster, Leah
Heimann, Shawn
Martinez, Kimberly
Miller, Clay
Mitchell, Marilyn
Nelson, Kristen
Pardington, Kari
Pedersen, Cynthia
Pelletier, Micky
Ragsdale, Rick
Rebmann, Sarah
Robicheaux, Hannah
Smith, Denise
Tollett, Brian
Vela, Tony
Morris, Paula
Content Area of Concern:
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Your answer
Student’s Name:
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Your answer
Student's Grade:
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Choose
6th
7th
8th
Special Population:
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Choose
SPED
504
RTI/MTSS
LEP/EL
GT
NONE
Current Grade:
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Your answer
Which grading period is the student currently failing?
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Choose
1st Progress Report
1st Six Weeks
2nd Progress Report
2nd Six Weeks
3rd Progress Report
3rd Six Weeks
1st Semester
4th Progress Report
4th Six Weeks
5th Progress Report
5th Six Weeks
6th Progress Report
2nd Semester
Year
Is the student in danger of losing credit? (Consider if they failed another six weeks)
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Choose
Yes, possibly the 1st Semester
Yes, possibly the 2nd Semester
Yes, possibly for the entire year
No, not at this time.
REASON(S) Be sure to provide requested SPECIFICS in the OTHER section below the reason(s):
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Missing assignments- Knows what to do, just does not get it completed/turned in (# of missing assignments need to be added at the bottom under section: other)
Low test grade performance (# with allowable makeup/retest, # missed opportunities for makeup/retest need to be added at the bottom under section: other)
Not understanding and/or missing work because of too many absences (# of absences need to be added at the bottom under section: other)
Not attending tutorials
Student turns in work but careless, sloppy, incomplete, and/or satisfied with low grades
Student does all assigned work but does not understand material at this time
Student does all assigned work but works slowly and grade are behind
Low test grade - option to retest has not been given yet.
Other:
Required
Teacher Concern Level
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Choose
High
Medium
Low
Main Overall Concern(s)/Reason(s) Student Is Failing Specifically:
Your answer
Parent Contacted (First and Last Name):
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Your answer
Initial Date Contacted:
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MM
/
DD
/
YYYY
Specific Email or Phone Number Used in Initial Contact Attempt(s):
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Your answer
If no personal contact was made:
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Message Was Left
Another Parent/Guardian was Contacted (If so, add the specifics with Name and Type of Contact in the OTHER section below this):
Will contact during lunch - or during conference
Other:
Required
Additional Date Contacted:
MM
/
DD
/
YYYY
Specific Email or Phone Number Used in Additional Contact Attempts:
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Your answer
If no personal contact was made:
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Message Was Left
Another Parent/Guardian was Contacted (If so, add the specifics with Name and Type of Contact in the OTHER section below this):
Other:
Required
If during any attempts, contact was made, what are the next step agreed upon by teacher and parent(s) (specifics discussed during conversation):
*
Your answer
A copy of your responses will be emailed to the address you provided.
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