DOCUMENT LIBRARY
Student/Parent/Teacher
Contract - Example
Place on School Stationery
Student Name _______________________ Date ____________
Reason for the conference:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
As a result of the conference, the student agrees to:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
As a result of the conference the parent(s) agrees to:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
As a result of the conference the teachers agree to:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Signatures below indicate the agreement of all parties to participate in the student’s success.
___________________________ ___________________________
Student Signature Parent Signature
___________________________ ___________________________
Teacher Signature Teacher Signature
___________________________ ___________________________
Teacher Signature Teacher Signature
___________________________
Counselor Signature