Student Behavior Contract Template

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Student Behavior Contract
Name_________________________________________________________________________
Dates of Contract: From__________________________ to _____________________________
The inappropriate behavior I will work on is:__________________________________________
______________________________________________________________________________
______________________________________________________________________________
I will change my behavior by:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The person I am going to practice controlling misbehavior with is:
______________________________________________________________________________
______________________________________________________________________________
The reward I want to receive for controlling my behavior is:______________________________
______________________________________________________________________________
______________________________________________________________________________
The penalty/consequence for using hurtful behavior is:__________________________________
______________________________________________________________________________
______________________________________________________________________________
Print student’s name:_____________________________________________________________
Student’s signature: ______________________________________________________________
Print staff’s name: _______________________________________________________________
Staff’s signature: ________________________________________________________________
_________
Date signed:________________________________ Follow up date to review:_____
Student Behavior Contract
Name_________________________________________________________________________
Dates of Contract: From__________________________ to _____________________________
The inappropriate behavior I will work on is:__________________________________________
______________________________________________________________________________
______________________________________________________________________________
I will change my behavior by:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
The person I am going to practice controlling misbehavior with is:
______________________________________________________________________________
______________________________________________________________________________
The reward I want to receive for controlling my behavior is:______________________________
______________________________________________________________________________
______________________________________________________________________________
The penalty/consequence for using hurtful behavior is:__________________________________
______________________________________________________________________________
______________________________________________________________________________
Print student’s name:_____________________________________________________________
Student’s signature: ______________________________________________________________
Print staff’s name: _______________________________________________________________
Staff’s signature: ________________________________________________________________
_________
Date signed:________________________________ Follow up date to review:_____

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