Curtis Classroom Self Check Behavior Form
Fill out the form below. Students in our class should remember to always Be Safe, Be Respectful, and Be Responsible!
* Required
Name:
*
Your answer
Select the appropriate sentence(s) below.
*
I am filling out this form because I was not BEING SAFE.
I am filling out this form because I was not BEING RESPECTFUL.
I am filling out this form because I was not BEING RESPONSIBLE.
Other:
Required
Using complete sentences please describe the problem that caused you to be sent to fill out the Self Check Behavior Form.
*
Your answer
Using complete sentences describe what was the setting that caused the behavior problem.
*
Your answer
Why were your actions a problem? Include reasons why your behavior may have hurt yourself or others. Use full sentences to answer the question. Include the question as part of your answer.
*
Your answer
How you can prevent or change this problem from being a problem in the future? Use full sentences to answer the question. Include the question as part of your answer.
*
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Uintah School District.
Report Abuse
Forms
