Student and/or Parent Contact Log
Cherokee Elementary School 2022-2023
Student Name:
*
First Name
Last Name
Grade Level:
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Teacher Name:
*
Last Name
Teacher Email (if completed, a copy of this from will be sent to the teacher)
example@example.com
Other staff (if completed, a copy of this from will be sent to the teacher)
example@example.com
Other staff (if completed, a copy of this from will be sent to the teacher)
example@example.com
Meeting with Student:
*
Yes
No
Date/Time of Student Meeting:
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Overview of Student Meeting:
Overview of Next Steps:
Parent Contact:
*
Yes
No
Date/Time of Parent Contact:
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Parent/Guardian's Name:
First Name
Last Name
Parent/Guardian Relationship to Student:
Parent/Guardian Phone Number:
Please enter a valid phone number.
Overview of Conversation:
Overview of Next Steps:
Form Submitted by:
*
Last Name
Date/Time of Form Submission:
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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