Student Reflection
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Student Name: (Last Name, First Name) *
Grade: *
What zone currently describes the way you are feeling right now? *
What happened? (Who was involved, where did this happen, describe the situation in detail, who initiated the issue/conflict.) *
When you think of this event, how were you feeling?  Which of the following sentence starters captures that feeling? *
Using the sentence starter you chose from the previous question, please complete the sentence in the space below describing your feelings about the incident. *
How have you been affected by this? *
Have others been affected by this event? If so, how? *
What needs to happen to help resolve this issue? (What needs to happen to help make things right?) *
Create a three (3) step plan to avoid this happening in the future. *
Here are some ways I could have helped avoid this situation: *
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Is there anything else you'd like to share? *
How can staff better support you in the future in the future? *
What zone currently describes the way you are feeling right now?
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