Reflection & Resolution Contract

Reflection Journal

StudentName: _________________________
Date / Time of incident: ____________________________
Time of incident: ________________

Please describe what happened in detail.

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Who was hurt or whose learning was impacted by what you did?
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Why did you choose to behave in this way? (You may use the 5 Whys analysis method to get at possible root causes!)
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What strategies could you have used to avoid behaving in that way? List (3) three that you could reasonably do.
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What will you try to do in the future?

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Remember ABCDs of measurable objectives: Audience (bywho), Behavior (does what), Conditions (under
what), degree (how long, how often, and criteria or rubric for evaluation of success or progress).

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Create a resolution for yourself that you believe you can accomplish to ensure that you achieving at your very best in
class. Your resolution must 1) describe the specific actions you will take, 2) explain how it will help you, and 3) state for
how long you will resolve to take these positive actions that youve created for yourself. Sign and date your promise!
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Student Signature: _____________________________ Date: ______________
Teachers Comments:
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Parents Comments:
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Student Signature: ___________________

Parent Signature / Date: _______________________

Teacher Signature / Date: ________________________