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Buckshutem Monthly Report
Please complete the form and submit.
NAME
*
First
Last
GRADE / POSITION
*
MONTH
*
Email (Optional)
STUDENTS ON ROLL
Boys
Girls
Black
Caucasian
Hispanic
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 GUIDANCE 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
VII. Noteworthy Accomplishments by You and/or Your Students This Month
VIII. FIELD TRIPS
None
Location
Date
MM
/
DD
/
YYYY
Learning Goals
Outcome
IX. Other Student Activities
X. STAFF ACTIVITIES
None
DATE and 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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