Buckshutem Road School Monthly Report

NAME *

GRADE/POSITION *

MONTH *

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I. STUDENTS ON ROLL:

Boys

Girls

Black

Hispanic

Caucasian

Other

Transfers In

Transfers Out

II. List the names of students referred to the I&RS TEAM this month:

III. List the names of students referred to the CHILD STUDY TEAM this month:

IV. List the names of students referred to the GUIDANCE COUNSELOR or SOCIAL WORKER this month:

V. List the names of students referred to the OFFICE for discipline reasons this month:

VI. LIST THE NAMES OF STUDENTS WHOSE ACADEMIC PROGRESS NEEDS TO BE DISCUSSED (by category):

	Low Performance	Average Performance	High Performance
	Low Performance	Average Performance	High Performance

VII. NOTEWORTHY ACCOMPLISHMENTS by you and/or your students this month:

VIII. FIELD TRIPS:

NONE

Date:

Location:

Learning Goals:

Outcome:

IX. Other Student Activities:

X. Staff Activities:

NONE

Date . . . . . . Title of in-service/ conference/ workshop/ committee

XI. CURRICULUM & INSTRUCTION

Please indicate the topics and page numbers you are currently working on in the following areas (as applicable):

Language Arts

Math

Science

Social Studies

Other Curriculum & Program Development Activities (e.g. Classroom Seminars)

XII. Grade Level/Subject Area Articulation meetings attended:

XIII. Facility/ Maintenance Concerns:

XIV. Other Comments, Suggestions, Concerns:

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