This form is a powerful addition to the Class Dojo behavior management system. For those students who need some extra reinforcement, this reflection form asks the student to look at his or her personal behaviors, and make a plan for how to improve as a student.
This is also a good way to communicate behavioral problems with parents, as it is presented in the words of the child himself.
I print out a copy of the student's weekly Class Dojo report, with the pie graph and list of behaviors. At the beginning of the year, I highlight the negative points so it is clear to the students what they need to focus on. I staple this report to the reflection sheet, and hand them out to the students who have fallen below 50% for the week on Monday morning, to be completed and returned by Tuesday morning.
Not only do the kids dislike spending the time writing the reflection, but it does actually cause them to stop and think about their own behavioral choices.