Student Name:

Week Dates:

Goal: I am working toward earning ___________________________ this week.

P
When you
give yourself
a rating for
todays class,
think about
these
questions

Monday
Comments

Tuesday
Comments

Wednesda
y
Comments

Thursday
Comments

Friday

Performanc
e
Did I complete the
warm-up problem?
Did I follow the
teachers directions
the first time
given?
Did I try every
practice problem
the teacher told us
to do?

Attentiveness Work-Ethic
Did I volunteer to
answer the teachers
questions?
Did I ask questions
when I was
confused?
Did I participate in
the class discussion/
activities?

Did I put forth my

best effort during
class?
Did I come to
class prepared?

Teacher
Comments:

Self-Review
Was I talking when the
teacher or another
student was talking?
Did I disrupt the class
in anyway?
Did the teacher need to
redirect me to the task?
Was I disrespectful
from the teacher or
another student?

Parent Signature:
Did the teacher need to
ask me to do my work?
Yes/no
Did the teacher need to
ask me to be quiet?
Yes/no
Was I disrespectful to
anyone during class?
Yes/no
Did the teacher need to
ask me to do my work?
Yes/no
Did the teacher need to
ask me to be quiet?
Yes/no
Was I disrespectful to
anyone during class?
Yes/no
Did the teacher need to
ask me to do my work?
Yes/no
Did the teacher need to
ask me to be quiet?
Yes/no
Was I disrespectful to
anyone during class?
Yes/no
Did the teacher need to
ask me to do my work?
Yes/no
Did the teacher need to
ask me to be quiet?
Yes/no
Was I disrespectful to
anyone during class?
Yes/no
Did the teacher need to
ask me to do my work?
Yes/no

Did my behavior during class thing week earn me my reward? Why or why not?

Student Name:
Comments

Week Dates:
Did the teacher need to
ask me to be quiet?
Yes/no
Was I disrespectful to
anyone during class?
Yes/no

Did my behavior during class thing week earn me my reward? Why or why not?