_____ Number

Discipline Form

________________ Date

Dear Mrs. Garrett,

I was ____________________________________________________________

__________________________________________________________________

I should have been ________________________________________________

__________________________________________________________________

To improve, I plan to ______________________________________________

__________________________________________________________________

Broken Key to Success:

__________________________________________________________________

__________________________________________________________________

Sincerely,

Keys to Success
1.	I can and I will do what I am asked, the first time I am asked, by any adult in this school.
2.	I can and I will RESPECT all people.  I can and I will do good deeds and say good things.
3.	I can and I will ask permission to speak or to leave my seat.
4.	I can and I will be prepared for class and do my best at all times.
5.	I can and I will walk quietly from place to place, in a straight line.
6.	I can and I will tell the truth at all times.