May 2024 Mt. Evans Behavior form

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First Name *

Last Name *

Teacher/Administrator *

Miss Brisse

Mr. Hamilton

Mrs. Larson

Mr. Richardson

Ms. Wall

Other - Principal, Elective Teacher, Substitute, or adult in the building

Date
*

YYYY

Issue resulting in form - check all that apply.
*

Chromebook issue - not charged, did not bring, off task/ gaming, emailing

Tardy to class --- (has more than 3 tardies in a quarter = Flight Maintenance)

Behavior issues - distracting, talking during instruction, not following directions

Missing supplies needed (even water bottle & RIOT book)

Incomplete or missing assignment

Required

Explain the issue(s) in one - or two sentences. (If you need help, just ask your teacher.)

Example: Chromebook issue

Example Sentence: My Chromebook was not charged for class today.

Example: Missing supplies and Behavior issue

Example Sentence: I didn't bring my math book, and I was talking while the teacher was teaching.

Action Taken -- check all that apply. *

I filled out this form and I had a verbal warning.

I filled out this form and I will miss lunch recess to (problem solving time - work to fix the issue causing the form.)

I have filled out this form and my computer has been taken away - You must ask your teacher for permission to get your device back.

I filled out this form and my parent(s) have been contacted (Student will email or phone call home) or by teacher (email or phone)

Required

I know that if I need to complete this form again, I may be asked to come in for a lunch discussion to create a plan to help me be successful. This may also include me calling or emailing my parent / guardian. *

Yes, I understand.

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