Monte Vista Reflection Room
Welcome to the Reflection Room. When you feel calm and ready, please take your time in filling out this form. When you are finished, please wait to meet with Mending Matters.
Your Name
Your answer
Student ID Number
Your answer
Which teacher sent you to the reflection room?
Your answer
What led you to being sent to the reflection room? *
Your answer
What are the classroom expectations and what do you think about these expectations? *
Your answer
In what ways were others in the classroom affected by this incident: You, Teacher and Peers?
Your answer
If you could go back, what could you have done differently?
Your answer
Is there anything you can do to make this right? (ex: talk one on one with teacher, write a letter, change your seat in class, etc.)
Your answer
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