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The student asked to go to the (bathroom, nurse, school counseling) today. Please circle requested destination.

The student used a 3-minute break pass today.

The student arrived on time to class.

Marquel traveled independently through the hallway, walking directly to his or her destination.

Katrina waited to be called on or given permission by the teacher before talking.

Katrina spoke respectfully and complied with adult requests without argument or complaint.

Katrina wrote down homework assignments correctly and completely.

Katrina turned in her completed homework on time.

Katrina was prepared for class, with all necessary school materials (e.g., books, pencils, papers).

Katrina left her seat only with permission during academic periods.

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