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Student Behavior Log
Within a 9 week Period :
1st time signing the behavior log - Warning
2nd time signing the behavior log - Student / Teacher conference
3rd time signing the behavior log - Student Unplug 1ce
4th time signing the behavior log - Student Unplug Class
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Date
MM
/
DD
/
YYYY
Reason for signing the behavior log (check multiple if necessary)
*
Talking during lesson
Disrespectful to teacher
Not following directions
Technology violation (playing games, using phone, etc)
Being unkind to another student
Other:
Required
I understand that if I don't change my behavior, this could lead to my teacher contacting my parents or writing a referral.
*
Yes
Is there anything you would like to let your teacher know?
Your answer
A copy of your responses will be emailed to the address you provided.
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