STUDENT AGREEMENT FORM
This Agreement is entered into between:
Student Name: _______________________________________
Date of Birth: ______________________________________
Grade/Class: _______________________________________
School Name: ______________________________________
Date: _____________________________________________
Purpose of the Agreement:
The purpose of this agreement is to outline the responsibilities, expectations, and commitments
required for the student’s participation in the (specify program, course, intervention, or
agreement type, such as academic improvement, behavior management, etc.).
Terms and Conditions:
By signing this agreement, the student agrees to the following terms:
1. Attendance and Punctuality:
o The student will attend all scheduled sessions/classes on time.
o In case of absence, the student will notify the responsible person (teacher,
counselor, etc.) in advance whenever possible.
2. Academic Commitment (if applicable):
o The student agrees to complete all assignments, projects, and exams as required.
o The student will seek help when needed, participate in class discussions, and
complete tasks within deadlines.
3. Behavioral Expectations:
o The student agrees to follow the school’s code of conduct and treat all individuals
with respect.
o Disruptive behavior, bullying, or any form of harassment will not be tolerated.
4. Respect for Property:
o The student agrees to take care of all school property and return any borrowed
items (books, equipment, etc.) in good condition.
5. Confidentiality:
o The student agrees to respect the confidentiality of any personal or sensitive
information shared within the school environment.
6. Communication:
o The student will regularly communicate with teachers or mentors regarding
progress or challenges.
7. Support and Participation (if applicable):
o The student will actively participate in any intervention, support programs, or
extracurricular activities agreed upon.
8. Responsibility for Actions:
o The student understands that failure to adhere to the agreement may result in
disciplinary action or a review of the student’s participation in the program or class.
Duration of Agreement:
This agreement is valid from:
Start Date: _______________________
End Date: ________________________
Acknowledgement and Consent:
By signing this agreement, I acknowledge and understand the terms and conditions outlined
above and agree to abide by them to the best of my ability.
Signature of Student: _______________________________
Date: ____________________________________________
Signature of Parent/Guardian (if applicable): _______________________________
Date: ____________________________________________
Signature of Teacher/Instructor: ___________________________
Date: ____________________________________________
