Teacher Generated Referral 17-18
Please record any 3rd Strikes or Flagrant Fouls that occur while supervising students. Communication between teachers and parents/guardian is critical when a student is sent to ISS. Please keep documentation this communication.
Student Name (Last, First)
Time of Incident
Non-ISS Referral (Documentation Only)
Use this to document when you confiscate a laptop or phone in class.
Flagrant Foul (Immediate Office Referral)
Briefly describe the behavior
Third Strike: Repeated Minor Behavior
Check all that apply to today's repeated problem behavior.
Cheating/Plagiarism (1st offense)
Correctable damage to school property
Misuse of technology
Use of offensive language
Function of Behavior
Access to preferred item/activity (seating, computer time, etc)
Obtain Adult Attention
Obtain Peer Attention
Select all of the interventions that you tried during this class period to correct the problem behavior.
Alternate assignment given
Buddy room placement
Conference with student/Conversation for Success
Neutralizing statement used ("See me after class" or "We will address this later.")
Parents/Guardians were/will be contacted:
via Latino Outreach Coordinator (email or call Eliana Lambert)
Send me a copy of my responses.
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