1. Describe reason(s) you received your first warning. 

2. Describe the behavior(s) that caused you to get a second warning.

3. Explain how your behavior affected the teaching and learning of others.

4. What will you do differently to avoid another warning

5. Write an apology to the teacher and students. (This will be presented at the beginning of the next class.)

Student Signature:                                                                                 Date:

Parent/Guardian Signature                                                        Date: