BEHAVIOR REFLECTION FORM

Name & Grade: ________________________________________________________

Department Assigned: __________________________________________________
Supervising Person: ____________________________________________________
In-School Suspension Dates: _____________________________________________

Directions: Read each question and answer them as thoroughly as possible. Do not
leave out any details and please be honest.

When did my inappropriate behavior occur? Where was it and who was present at the
time?

What bad choice did I make?

What negative outcomes occur when I use unacceptable behavior?

What could I have done instead?

What might positive outcome may occur if I choose an appropriate behavior to handle my
problem?

PLEASE TURN PAPER OVER TO COMPLETE

THE BEHAVIOR REFLECTION FORM.
© Guidance Service 2019
Letter to Parents
Direction: The letter you write to your parent will inform them about what happen and
explain how you will not display the behavior that got you referred to the dean’s office.

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Reflection
Direction: Your own reflection should tell how this In-School Suspension has helped you
become a better person and has improved your attitude and behavior.

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PLEASE TURN IN THIS DOCUMENT TO GUIDANCE COUNSELOR UPON COMPLETION AND

WAIT FOR FURTHE DIRECTIONS. THANK YOU.

© Guidance Service 2019