These questions are targeted towards students that have been assigned a disciplinary action or consequence, this includes detentions, suspensions, disciplinary hearings, etc.
This questionnaire is focused on collecting DATA, assessing the student, and measuring our effect on the student.
This document is PART 1. This is the check-in survey (prior to a serious consequence) PART 2 should be taken after an intervention has been applied and the school/teacher/administrator is trying to assess the process.
This is a .docx file (so you should be able to edit it). Please let me know if you would like it sent in another form. However, I used this as a google form. I had each of these questions set-up as an online questionnaire on google forms so that it could be tracked in a spreadsheet. Also, students are more receptive to work/activities that allow them to have computer privileges.