Student name:

1. Briefly describe the situation:

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2. What are your feelings about the situation?

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3. Do you care about the people that are involved?

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4. Is this the first occurrence? _______________________________

5. What is your main concern in this situation?

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Student name:

6. How do you think the other people involved feel?

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7. How does the other people affected in this situation feel?

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8. How can this situation be resolved?

1. Goal

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2. Action steps to reach that goal

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