This resource gives the students an opportunity for them to reflect on their learning and to make changes. The form asks the student to think about why he or she received that score. The student will also need to cite three activities that he or she will do to better understand the concept. Such activities could include coming in before or after school, or staying in at recess to work with the teacher or another student who understands the concept.
Included in this resource is a scoring sheet for the teacher to help keep track of the original scores and the retake scores. Organization is key!
I use this resource primarily with math, but it could be used with any subject area or assignment.