YOU HAVE BEEN PINK SLIPPED!!!

Written Warning Behavior Sheet

Consider yourself WARNED that your behavior was inappropriate in class today.
(* Note: Further disciplinary actions might be taken if this is not the first written
warning!)

I was a NUISANCE in Mrs. Costisick’s class today for the following reason(s):

____A.) I was tardy—I was not in my seat when the bell rang.

____B.) I talked so much that I disrupted the class today.

____C.) I spoke in a rude manner to another student or the teacher.

____D.) I would not stay at my desk, and instead wandered around the classroom or
moved to another desk.

____E.) I would not do my assigned work or I stopped working early.

____F.) I could not sit at my assigned desk without physically bothering another person
and/or their property.

____G.) I interrupted the class routine by speaking out in a loud voice without permission
(w/o raising hand).

____H.) I exhibited inappropriate behavior while attending a class activity outside the
classroom.

____I.) I fell asleep in class or didn’t complete work because my head was down on the
desk or my eyes were closed.

____J.) I was not prepared for class today—I did not have my class supplies, textbook,
homework or project.

____K.) OTHER:
______________________________________________________________________________

COMPLETE THE FOLLOWING (Failure to complete any part results in a

disciplinary notice to Principals!!!):

Explanation of Behavior:

Choose one:
____ 1.) Explain how you will improve. I can correct this problem on my own:
____ 2.) I need help with this problem. Please involve my parents and/or the Principals.

Parent Name: ___________________________________________________________________________

Contact # or e-mail:
________________________________________________________________________

Signature: ____________________________________________________________ Date:

_______________________