Name:  Teacher:  Class/Course:  Date:

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Negotiable Items---------------------------------------------------------------------------------------------------------------------------
Teacher Responsibilities---------------------------------------------------------------------------------------------------------------
Sign-Offs-------------------------------------------------------------------------------------------------------------------------------------
Non-Negotiable Items--------------------------------------------------------------------------------------------------------------------
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[Student Name]
[Teacher
Name]
[Course Title]
[Date]
[Contract Title]
I am taking part in this learning contract because the strategies listed here will help me to learn the material
and perform well in this course. This contract is in effect through the end of the current semester.
I have chosen to complete the following actions:
I am also expected to complete the following actions:
My teacher will help me to achieve success in this course through these actions/supports:
1.
2.
3.
4.
Teacher
[Student Name]
Student
[Parent Name]
Parent