This is a 1/3 sheet of paper for a student to fill out if they did not follow the classroom procedures. It has a quote for them to read and reflect on and then lines for them to answer two questions. This is a great tool for students to have a consequence for their actions (that is not punitive). I usually have the students step into the hallway, fill it out, and re-enter the learning environment as soon as it is complete. I also keep these and bring them to parent conferences or IEP meetings as data.