This is a sheet for kids who are in time-out, or need to reflect upon their poor behavior choices and decide what they can do next time. It has a four sections:
- Write or draw what you did
- Circle the rule you broke
- Who was hurt by my behavior? (the teacher, the other students, me)
- What will I do differently next time? (write or draw)
There is space at the bottom for the student's signature, a teacher or parent's signature, and the date.
I particularly like this form because I worked to create avatars for my typical students: an African American boy and girl (the girl in a hijab), and a Hispanic or White boy and girl.