Student Behavior Contract 
 
 
Name_________________________________________________________________________ 
 
Dates of Contract:  From__________________________ to _____________________________ 
 
The inappropriate behavior I will work on is:__________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
I will change my behavior by: 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
The person I am going to practice controlling misbehavior with is: 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
The reward I want to receive for controlling my behavior is:______________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
The penalty/consequence for using hurtful behavior is:__________________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
Print student’s name:_____________________________________________________________  
 
Student’s signature: ______________________________________________________________ 
 
Print staff’s name: _______________________________________________________________ 
 
Staff’s signature: ________________________________________________________________ 
 
Date signed:________________________________ Follow up date to review:_____
_________