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Procedures
____________________________________________
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Student Signature
Date
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Parent Signature
Below the line behaviors
Social
Emotional
Date
Physical
Spreading Rumors
Insulting gestures Hitting
Telling others not to be friends Name-calling
Kicking
Excluding or Ostracizing
Taunting or threats
Harming
Property
Humiliating
Rude Comments Inappropriate Touching
Cyberbullying
Use of electronic devices such as social media, cell phones, texting,
use of computer/tablet, or webcams
I understand if I demonstrate a below the line behavior, the
following consequences will occur.
First incident: Intervene and identify the behavior as below the line.
Teacher will state his/her expectations and give verbal warning and
record incident.
Second incident: Follow same procedure as the first. In addition,
restrict time from activities for 1 day. Students will complete a thinking
activity to reflect on their actions either through writing or drawing. In
addition, notify parents via email or phone call.
Third incident: Follow same procedure as the first and second.
Restrict time from activity for 3 days. School counselor will consult
with student.
Fourth incident: Follow same procedure as previously stated. Send
student to an administrator. A parent conference will be scheduled
with an administrator, school counselor, and student.
---------------------------------------------------------------------Please sign and return this portion of the form to your childs
teacher.
Students Name _______________________________ Grade
_______
Teachers Name_______________________________
I am aware of the Dogwood Elementary Below the Line plan.
I have discussed this plan with my child.
Parents Signature____________________________ Date_________