Student  Name:  ___________________________________________________________  

 
Referring  Staff:  __________________________________________  Date:  ___________________________  
 
 
Restorative  Conversations  
 
 
 
1. What  happened?  
 
 
 
 
 
2. Where  did  it  happen?  
 
 
 
 
3. Who  was  involved?  
 
 
 
 
4. What  were  you  thinking  at  the  time?  
 
 
 
 
 
5. What  have  you  thought  about  since?  
 
 
 
 
 
6. Who  do  you  think  has  been  affected  by  what  you  did?  
 
 
 
 
 
 
 7. In  what  way  do  you  think  they  were  affected?  
 
 
 
 
 
8. Was  what  you  did  the  right  or  wrong  thing  to  do?  
 
 
 
 
 
9. If  you  had  it  to  do  over,  what  would  you  do  differently?    
 
   
   
 
 
10. What  do  you  need  to  do  to  make  things  right?  
 
   
 
 
 
 
11. What  exactly  are  you  sorry  for?  
 
 
 
 
 
 
12. How  can  we  make  sure  this  doesn’t  happen  again?  
 
 
 
   
 
13. What  can  we  do  to  help  you?    
 
 
 
 
 
 
Relationships  .  Respect  .  Responsibility  .  Restoration  .  Reintegration