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Student Responsibility Forms

Student Responsibility Forms encourage student accountability while giving students the opportunity to explain why they chose not to follow a classroom expectation. Students receive a form when they do not meet a classroom expectation, such as following directions after a teacher request. In addition to increasing personal responsibility, the form also serves as documentation that can be used by the teacher during parent-teacher conferences or administrative meetings.

How to use

1. Create the Student Responsibility Form

Decide what behaviors you will want to address with your form. Some teachers use forms for missed homework assignments only. Other teachers choose to use them for certain types of off-task behavior. If you choose to use the Student Responsibility Form for more than one behavior, list the possibilities on the form. Check off the behavior before you hand the form to the student. Make a place for the student to explain why he or she demonstrated the behavior and a place for the student to sign the slip, indicating they acknowledge the infraction.

2. Set expectations

Once students have been taught procedures and expectations, they should be taught about the Student Responsibility Form procedure. Not following the set expectations means receiving a notification, just like students would receive when they have a job. It’s important that students understand that the teacher will show forms to their parents and administration, if necessary.

3. Decide on consequences

Decide and explain how students will be penalized as they accumulate Student Responsibility Forms. For example, three forms for off-task behavior could result in parent contact. Receiving a form for not completing a homework assignment could mean that 5 points will be taken off the weekly participation grade.

4. Distribute the form

Any time a student fails to meet a classroom expectation, hand him or her a Student Responsibility Form. Allow the student time to complete the form, explaining why he or she chose not to follow the classroom expectation.

5. File the form

Collect and place the form in the student’s file or in a filing system of your choice.

When to use

Use Student Responsibility Forms to encourage accountability for behaviors you are trying to reduce in your classroom:
• Missing homework assignment
• Not having necessary supplies
• Not participating in class
• Distracting other students


Pink Slips - or Other Color Slips

Some teachers use colored paper for the Student Responsibility Forms and call the forms by that color. Pink is a popular color, so teachers can say they are issuing Pink Slips for behavior that is keeping students from the business of learning.

Parent Signature

You might decide to give further weight to the forms by having students take them home to be signed by a parent or guardian.

Class-wide Motivation System with Student Responsibility Forms

Depending on why you are issuing forms, you might want to have a competition between classes: the class with the fewest amount of issued forms each six weeks earns a reward. Or you could have a weekly class reward: if no Student Responsibility Forms are issued during the week, the class receives a reward.

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