| Student: | Date:
|
| Teacher/School Personnel:
| Parent/Guardian:
|
| What behavior(s) will the student work on (state positively):
1. 2. 3. | |
| Daily Goal:
| |
| If ______reaches daily goal, then she/he/they will choose one of the following:
1. 2. 3. | |
| Weekly Goal:
| |
| If ______reaches weekly goal, then she/he/they will choose one of the following:
1. 2. 3. | |
| To support achieving the behavior goals, ___________, will use the following forms of pre-corrective feedback and encouragement:
1. 2. 3. | |
| I helped to create this contract, understand it and agree to the terms.
Student Signature: _____________________________ | |
| I helped to create this contract, understand it and agree to the terms.
Parent/Guardian Signature: _________________________ | |
| I helped to create this contract, understand it and agree to the terms.
Teacher/School Personnel Signature: ___________________________ | |