Did you follow directions appropriately? Yes _____ No _____
What was your behavior? ______________________________________ _________________________________________________________ _________________________________________________________ What did you want? (put a check next to the appropriate statement) ____ I wanted attention from others. ____ I wanted to be in control. ____ I wanted to avoid doing my homework. ____ I wanted to cause problems because I am sad inside. ____ I wanted to cause other problems because they dont like me. ____ I wanted ___________________________________ Did you get what you wanted? Yes _____
No _____
What could you do differently? _________________________________
_________________________________________________________ _________________________________________________________ Will you be able to return to class appropriately? Yes _____ No _____