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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
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

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Student Behavior Reflection

  • 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