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REFOCUS ROOM ENTRY TICKET 21-22
This form must be filled out EVERY TIME a student is utilizing the Refocus Room.
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* Indicates required question
Date for Refocus Entry
*
MM
/
DD
/
YYYY
Student Name
*
Your answer
Grade
*
Choose
7
8
9
10
11
12
Period
*
Choose
1
2
3
4
5
6
7
Lunch Plus
Lunch Detention
Teacher
*
Your answer
Assignment/Sending Teacher Comments
*
Your answer
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