Restorative Intervention Form 2017-18, Online Collaborative Problem Solving
This form should take you no LESS than 20 minutes to complete. You should look at what time it is before you get started and what time it is when you are finished. If your responses do not seem to indicate a twenty minutes worth of thoughtful self-reflection, you will be asked to re-do the form or face more serious consequences. Your responses should be written in complete sentences that demonstrate careful adherence to English language conventions such as capitalization, spelling and punctuation; failure to do so could also result in the rejection of this form.

Before you fill out this form, please review the Behavioral Norms and Expectations (TAP-UP).


This form must be completed within 24 hours of your receipt of the RIF Ticket.

LAST NAME *
What is your LAST name? Please type your LAST name.
Your answer
FIRST NAME *
What is your FIRST name? Please type your FIRST name.
Your answer
TEACHER *
Please choose the name of the teacher who assigned you this online problem solving form.
Behavioral Norms and Expectations (TAP-UP) *
Which Behavioral Expectation did you violate?
Your answer
WHAT HAPPENED? *
What did you do to violate the expectation? Explain what actions of yours led you to this RIF today.
Your answer
Sentiment *
How are you feeling about what happened?
Your answer
Expectation *
What were you supposed to be doing at the time of the violation?
Your answer
Impact *
How did the violation impact your own learning?
Your answer
Others *
How did the violation impact the learning of others?
Your answer
Options *
What could you have done instead that would have been a better choice?
Your answer
Moving Forward *
What will you do in the future to ensure that you will not repeat the same offense?
Your answer
Faculty *
What can the adults in the building do to support your change in behavior?
Your answer
Problem Solve *
What else can you do for yourself to remain on track?
Your answer
Submit
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