Discipline Form by W71DA7x3

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									                                                   Discipline Record 2010 - 2011
Student                                                                                 NCWISE #                           PERIOD
            First                    Middle                         Last
                 M         T           W            TH             F                         M          T          W             TH                F
                                25            26         27                                        1        2              3             4



                                                                           February
            30        31                                                                7          8        9              10            11


August
                                1             2          3                              14         15       16             17            1/2 DAY



September
            HOLIDAY   7         8             9          10                             WORKDAY    22       23             24            25




            13        14        15            16         17                             28




            20        21        22            23         24                                        1        2              3             WORKDAY



                                                                           March
            27        28        29            30                                        7          8        9              10            11




                                                         1/2 DAY                        14         15       16             17            18



October
            4         5         6             7          8                              21         22       23             24            25




            11        12        13            14         15                             28         29       30             31            WORKDAY




            18        19        20            21         22                             4          5        6              7             8



                                                                           April
            25        26        27            28         WORKDAY                        11         12       13             14            15




            1         2         3             4          5                              18         19       20             21            22




            8         9         10            HOLIDAY    12                             2          3        4              5             6



November                                                                   May
            15        16        17            18         19                             9          10       11             12            13




            22        23        WORKDAY       HOLIDAY    HOLIDAY                        16         17       18             19            20




            29        30                                                                23         24       25             26            27




                                1             2          3                              HOLIDAY    31


December
            6         7         8             9          10                                                 1              2             3



                                                                           June
            13        14        15            16         17                             6          7        8              9             10




            3         4         5             6          7


January                                                                               Behavior Codes                    Action Codes
            10        11        12            13         14
                                                                             Excessive Talking     T                   Warning                 W
                                                                              Foul Language        FL
            HOLIDAY   18        19            20         21
                                                                              Electronic Devices E
                                                                                                                     Phone Call                    P
                                                                               Insubordinate     IN
            WORKDAY   WORKDAY   26            27         28
                                                                                   Verbal Threat   V              Letter To Parents                L
                                                                                    Fighting       F
            31
                                                                                   Unprepared      U                 Conference                    C
                                                                                   Sleeping        S

                                                                              Throwing Objects     TH            Disciplinary Referral             R
                                                   Student Information


Student
                               First                                Middle                    Last

NCWISE #                                                         Period                  Birthdate            /       /
                          Information Provided Below Will Be Used Discreetly and In Emergency Situations

Parent's Name
                               First                                Middle                    Last

Parent's Relationship To Student

Parent's Home #            (           )                           Parent's Cell #      (            )

Parent's Work #            (           )                           Work Location

Email Address


Parent's Name
                               First                                Middle                    Last

Parent's Relationship To Student

Parent's Home #            (           )                           Parent's Cell #      (            )

Parent's Work #            (           )                           Work Location

Email Address


Mailing Address

911 Address




                           City                                 State                   Zip Code

Does student have access to a computer with Microsoft Word?                             Yes              No
Does student have access to a computer with Microsoft PowerPoint?                       Yes              No
Does student have access to the internet?                                               Yes              No

  Please include any
additional information,
  health concerns, or
special considerations.
             By signing, I am aware of the discipline procedures used in this class and the teacher's expectations.

Student's Signature                                             Parent's Signature
                      Parent Contact Log



Date   Student Name   Type of Contact      Conversation

								
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