Chronic behaviors may result in loss of lab privileges, phone calls

home, conferences and administrative referrals.

Check the behaviors that resulted in getting this form. On the back explain in detail, why
this behavior is NOT acceptable in science class.

1 ______ Comes to school without school supplies

2 ______ Does not do assignments / does not turn them in.

3 ______ Does not follow directions on the first request / complies only to return
to negative behavior.

4 ______ Does not stay on task and behavior results in incomplete work or others
incomplete work (requires FREQUENT reminders to behave and get to work).
5 ______ Monopolizing class time with irrelevant discussions, repetition of al-
ready reviewed material (unnecessary questions about page number, and where to
write name and date, ect.)

6 ______ Chewing gum, eating or drinking

(Has been made aware of this rule since day 1).
7 ______ Expressing anger inappropriately/not listening to teachers full requests.

8 ______ Going to backpack during class without asking / packing up early.

9 ______ Interference with a discipline attempt. Arguing with teacher.

10 ______ Interrupting or intruding on others, engaging in private conversation

during instruction. Unnecessary verbal comments that are meant to be
disruptive.
11 ______ Lying, cheating, damaging property, stealing. Taking/hiding other peo-
ple’s things.
12 ______ Not cleaning up after yourself.

13 ______ Not staying in assigned seat.

14 ______ Play fighting/silliness, goofing around at inappropriate times. Unsafe

behavior during a LAB/experiment/class.

15 ______ Throwing things.

16 ______ Unnecessary loud disruptive talk or noises that distracts others, pencil/
foot tapping.
17 ______ Inappropriate touching of others, verbal assault, name calling, put
downs.
18 ______ OTHER … Describe: _______________________________________________

THESE RULES HAVE BEEN IN PLACE ALL YEAR…

Answer the questions below in a COMPLETE SENTENCE:
Not writing in complete sentences will result in redoing the contract.

What behavior got you in trouble?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Why do you think it got you in trouble?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Is this behavior helping you learn? Why not?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

How will you change this behavior?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Student Signature:_________________________________________________________________

Parent Signature:__________________________________________________________________

Contract: 1__________ 2__________ Teacher Signature:_________________________

* Contract 1: Student fills out contract and parent signature

*Contract 2: Student fills out contract and parent signature
**After Contract 2, teacher starts accountability card