Do not write in
this section.
Returned Forms: Class/Dept. Guidelines
Syllabus
STUDENT INFORMATION SHEET (please PRINT clearly)
Mr. York
(Check one) World Geography
U.S. History
Name:
Birthday:
Address:
Phone #:
City, State, ZIP Code:
I live with my:
Father/Guardian
Mother/Guardian
Name:
first
last
first
last
Workplace:
Work phone #:
Cell phone #:
E-mail address:
PERIOD
CLASS
CLASS SCHEDULE
ROOM #
TEACHER
1
2
3
4
5
6
7
8
Locker Number_______________
Locker Combination _____________________________________
Last Years School?____________________
History Teachers Name________________
Extracurricular Activities (band, agriculture, volleyball, football, swimming, pep squad, debate, etc.):
Activity
Sponsor/Coach
Activity
DATE
Date:
Time:
Date:
Time:
Date:
Time:
Date:
Time:
Date:
Time:
CIRCUMSTANCE
Sponsor/Coach
NOTES
COMMUNICATION
COMMENTS
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
conference with student
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
Date:
Time:
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
Contact Information
Student/Parent
Communication
DATE
CIRCUMSTANCE
NOTES
Date:
Time:
Date:
Time:
Date:
Time:
Date:
Time:
Date:
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
accepted until __________ max grade ____
other:
Name _______________________________
World Geography U.S. History
COMMUNICATION
COMMENTS
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
conference with student
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
student conference
email
letter home
office referral
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
Time:
Date:
Time:
Date:
Time:
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
phone call @ home
work
mother father
guardian
message no answer
other:
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
absence notification
academics
dishonesty
failing/failure
low grade
missing assignment(s)
progress report
behavior/discipline
response to parent
contact
other
student conference
email
letter home
office referral
phone call @ home
work
mother father
guardian
message no answer
other:
discussed resolved continuing
conference requested _________________
grade penalty -N.C. -11 -22 -33
-50
assignment _________________________
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
accepted until __________ max grade ____
other:
