Behavior reflection form teacher and student

Behavior reflection form teacher and student

• 1.
  (subject ) Today in______________________ class I made a poor choice. My poor choice was my decision to ________________________________ ________________________________________________________________ ________________________________________________________________ The events that led up to my poor choice were ___________________________________________ _________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ __________________________________________________________________________ _________________________________________________________________________ Next time I will change my actions by _______________________________________ _____________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ The consequence(s) of my actions should be ____________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Student Name: Grade: Teacher: Parents: Please review the back of this page for teacher observations and recommendations. STUDENT BEHAVIOR REFLECTION Created by Amy Bultena www.artfulartsyamy.com @artfulartsyamy
• 2.
  Student Name: Grade:Teacher: Teacher observations of situation leading to student reflection _______ __________________________________________________________________ _____________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Actions taken by the teacher ____________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Teacher reflections on student-chosen consequence and/or teacher assigned consequence __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Number of times student has completed the Behavior Reflection form during ________ term. __________________________________________________________________________________________________________ Overall impact on student’s conduct grade _______________________________________________ __________________________________________________________________________________________________________ This form is used to help students reflect upon choices made in the classroom, and to help them devise better solutions the next time such a situation should arise. Guardian Signature _________________________________________________ Date _____________ TEACHER BEHAVIOR REFLECTION Created by Amy Bultena www.artfulartsyamy.com @artfulartsyamy