th

4 -5th STUDENT SELF-

REFLECTION FORM
Includes a version for
students and teachers!

FREEBIE!
CREATED BY: TO THE FOURTH & BEYOND
© 2019 – TOTHEFOURTHANDBEYOND
 SELF-REFLECTION
Name: ______________________
Behavior & Work Habits q v j k
I follow school and classroom rules.

I show respect to my teacher and classmates by acting appropriately during class.

I stay on-task during class and use my time wisely.

I keep my materials organized and I can always find my materials.

I turn in my assignments on time.

I listen to and follow directions.

My work is done neatly and I check to make sure it’s my best work.

I work independently in class and use my resources correctly.

I participate 100% every time we “turn and talk” or “talk with our groups.”

I understand that mistakes are a part of the learning process, and I will make them.

I control my talking.

I work hard everyday.

I always accept responsibility for my actions.

I work well with others in my group.

I work well with others in PE.

I work well with others at recess.

I am able to control my emotions and calm-down when feeling strong emotions.

I always have a positive attitude.

I will say I’m sorry when I know I have made a mistake.

I demonstrate self-control.

I ask for help when I need it.

I can focus my attention during lessons and at other times when needed.

I enjoy reading.

I enjoy math.

I have learned a lot this school year.

COMMENTS

© 2019 – Anna Monteil

 4th grade mathematics q v j k
I know what a growth mindset is.

I have a growth mindset, and I know that my brain can learn anything.

I understand how to multiply 2-digit by 2-digit numbers.

I know how to divide 3 and 4-digit dividends by 1-digit divisors.

I understand the difference between a dividend and a divisor.

I can add and subtract fractions.

I can add and subtract whole numbers.

I can convert a mixed number to an improper fraction.

I can find equivalent fractions.

I understand the place value systems from ones to millions.

I pass most of my math tests on the first try.

I pay attention and participate in all math lessons.

I give my best effort when completing math assignments.

I use my time wisely during math “work times.”

I understand almost every math lesson.

reading/writing q v j k
I read the entire time during time in text, everyday.

I pay attention and participate in all reading lessons.

I give my best effort when completing reading assignments.

I read at home every “school night” for 30 minutes.

I used my time wisely during reading “work times.”

I write in complete sentences, using capitals & punctuation.

I spell words correctly in my writing. I use resources to check my spelling.

I write in neat legible handwriting.

I can take well-organized notes on anything I read.

I understand what I read.

I can find the main idea of a text.

I can identify the text structure of a text.

I can identify the theme of a text.

I can summarize a story.

I can determine point of view.

I can compare and contrast.

I know what an opinion essay looks like and how to write one.

I know what an informative essay/report looks like and how to write one.

I know what a narrative looks like and how to write one.

I know what a noun, verb, and adjective are.

© 2019 – Anna Monteil

 FEEDBACK FORM
Name: ______________________
Behavior & Work Habits q v j k
The student follows school and classroom rules.

The student shows respect by acting appropriately during class.

The student stays on-task during class and uses their time wisely.

The student keeps their materials organized and I can always find my materials.

The student turns in their assignments on time.

The student listens to and follows directions.

The student’s work is done neatly and they check to make sure it’s their best work.

The student works independently in class and uses their resources correctly.

The student participates 100% every time we “turn and talk” or “talk with our groups.”

The student understands that mistakes are a part of the learning process.

The student controls their talking.

The student works hard everyday.

The student always accept responsibility for their actions.

The student works well with others in their group.

The student works well with others in PE.

The student works well with others at recess.

The student is able to control their emotions and calm-down when feeling strong emotions.

The student always has a positive attitude.

The student will say I’m sorry when they know they have made a mistake.

The student demonstrates self-control.

The student asks for help when they need it.

The student can focus their attention during lessons and at other times when needed.

The student enjoys reading.

The student enjoys math.

The student has learned a lot this school year.

COMMENTS

© 2019 – Anna Monteil

 4th grade mathematics q v j k
The student knows what a growth mindset is.

The student has a growth mindset, and knows that their brain can learn anything.

The student understands how to multiply 2-digit by 2-digit numbers.

The student knows how to divide 3 and 4-digit dividends by 1-digit divisors.

The student understands the difference between a dividend and a divisor.

The student can add and subtract fractions.

The student can add and subtract whole numbers.

The student can convert a mixed number to an improper fraction.

The student can find equivalent fractions.

The student understands the place value systems from ones to millions.

The student passes most of my math tests on the first try.

The student pays attention and participates in all math lessons.

The student gives their best effort when completing math assignments.

The student uses their time wisely during math “work times.”

The student understands almost every math lesson.

reading/writing q v j k
The student reads the entire time during time in text, everyday.

The student pays attention and participates in all reading lessons.

The student gives their best effort when completing reading assignments.

The student reads at home every “school night” for 30 minutes.

The student uses their time wisely during reading “work times.”

The student writes in complete sentences, using capitals & punctuation.

The student spells words correctly in their writing. They use resources to check my spelling.

The student writes in neat legible handwriting.

The student can take well-organized notes on anything they read.

The student understands what they read.

The student can find the main idea of a text.

The student can identify the text structure of a text.

The student can identify the theme of a text.

The student can summarize a story.

The student can determine point of view.

The student can compare and contrast.

The student knows what an opinion essay looks like and how to write one.

The student knows what an informative essay/report looks like and how to write one.

The student knows what a narrative looks like and how to write one.

The student knows what a noun, verb, and adjective are.

© 2019 – Anna Monteil

 mathematics q v j k
I know what a growth mindset is.

I have a growth mindset, and I know that my brain can learn anything.

I understand how to multiply 2-digit by 2-digit numbers.

I know how to divide 3 and 4-digit dividends by 1-digit divisors.

I understand the difference between a dividend and a divisor.

I can add and subtract fractions.

I can add and subtract whole numbers.

I can convert a mixed number to an improper fraction.

I can find equivalent fractions.

I understand the place value systems from ones to millions.

I pass most of my math tests on the first try.

I pay attention and participate in all math lessons.

I give my best effort when completing math assignments.

I use my time wisely during math “work times.”

I understand almost every math lesson.

reading/writing q v j k
I read the entire time during time in text, everyday.

I pay attention and participate in all reading lessons.

I give my best effort when completing reading assignments.

I read at home every “school night” for 30 minutes.

I used my time wisely during reading “work times.”

I write in complete sentences, using capitals & punctuation.

I spell words correctly in my writing. I use resources to check my spelling.

I write in neat legible handwriting.

I can take well-organized notes on anything I read.

I understand what I read.

I can find the main idea of a text.

I can identify the text structure of a text.

I can identify the theme of a text.

I can summarize a story.

I can determine point of view.

I can compare and contrast.

I know what an opinion essay looks like and how to write one.

I know what an informative essay/report looks like and how to write one.

I know what a narrative looks like and how to write one.

I know what a noun, verb, and adjective are.

© 2019 – Anna Monteil

 mathematics q v j k
The student knows what a growth mindset is.

The student has a growth mindset, and knows that their brain can learn anything.

The student understands how to multiply 2-digit by 2-digit numbers.

The student knows how to divide 3 and 4-digit dividends by 1-digit divisors.

The student understands the difference between a dividend and a divisor.

The student can add and subtract fractions.

The student can add and subtract whole numbers.

The student can convert a mixed number to an improper fraction.

The student can find equivalent fractions.

The student understands the place value systems from ones to millions.

The student passes most of my math tests on the first try.

The student pays attention and participates in all math lessons.

The student gives their best effort when completing math assignments.

The student uses their time wisely during math “work times.”

The student understands almost every math lesson.

reading/writing q v j k
The student reads the entire time during time in text, everyday.

The student pays attention and participates in all reading lessons.

The student gives their best effort when completing reading assignments.

The student reads at home every “school night” for 30 minutes.

The student uses their time wisely during reading “work times.”

The student writes in complete sentences, using capitals & punctuation.

The student spells words correctly in their writing. They use resources to check my spelling.

The student writes in neat legible handwriting.

The student can take well-organized notes on anything they read.

The student understands what they read.

The student can find the main idea of a text.

The student can identify the text structure of a text.

The student can identify the theme of a text.

The student can summarize a story.

The student can determine point of view.

The student can compare and contrast.

The student knows what an opinion essay looks like and how to write one.

The student knows what an informative essay/report looks like and how to write one.

The student knows what a narrative looks like and how to write one.

The student knows what a noun, verb, and adjective are.

© 2019 – Anna Monteil

 SELF-REFLECTION
Name: ______________________
Behavior & Work Habits q v j k
I follow school and classroom rules.

I show respect to my teacher and classmates by acting appropriately during class.

I stay on-task during class and use my time wisely.

I keep my materials organized and I can always find my materials.

I turn in my assignments on time.

I listen to and follow directions.

My work is done neatly and I check to make sure it’s my best work.

I work independently in class and use my resources correctly.

I participate 100% every time we “turn and talk” or “talk with our groups.”

I understand that mistakes are a part of the learning process, and I will make them.

I control my talking.

I work hard everyday.

I always accept responsibility for my actions.

I work well with others in my group.

I work well with others in PE.

I work well with others at recess.

I am able to control my emotions and calm-down when feeling strong emotions.

I always have a positive attitude.

I will say I’m sorry when I know I have made a mistake.

I demonstrate self-control.

I ask for help when I need it.

I can focus my attention during lessons and at other times when needed.

I enjoy reading.

I enjoy math.

I have learned a lot this school year.

COMMENTS

© 2019 – Anna Monteil

 5th grade mathematics q v j k
I know what a growth mindset is.

I have a growth mindset, I know that my brain can learn anything.

I understand how to multiply 3-digit numbers by 3 or 4-digit numbers.

I know how to divide 3 or 4-digit numbers by 2-digit divisors.

I understand the difference between a dividend and a divisor.

I can add and subtract fractions and mixed numbers.

I know a fraction is the same as a division problem. 5/8= 5 divided by 8.

I can multiply a fraction by a fraction and draw model.

I can turn fractions into decimals and multiply and divide decimals.

I can find the volume of a rectangular prism.

I pass most of my math tests on the first try.

I pay attention and participate in all math lessons.

I give my best effort when completing math assignments.

I use my time wisely during math “work times.”

I understand almost every math lesson.

reading/writing q v j k
I read the entire time during time in text, everyday.

I pay attention and participate in all reading lessons.

I give my best effort when completing reading assignments.

I read at home every “school night” for 30 minutes.

I used my time wisely during reading “work times.”

I write in complete sentences, using capitals & punctuation.

I spell words correctly in my writing. I use resources to check my spelling.

I write in neat legible handwriting.

I can take well-organized notes on anything I read.

I understand what I read.

I can find the main idea of a text.

I can identify the text structure of a text.

I can identify the theme of a text.

I can summarize a story.

I can determine point of view.

I can compare and contrast.

I know what an opinion essay looks like and how to write one.

I know what an informative essay/report looks like and how to write one.

I know what a narrative looks like and how to write one.

I know what a noun, verb, and adjective are.

© 2019 – Anna Monteil
 FEEDBACK FORM
Name: ______________________
Behavior & Work Habits q v j k
The student follows school and classroom rules.

The student shows respect by acting appropriately during class.

The student stays on-task during class and uses their time wisely.

The student keeps their materials organized and I can always find my materials.

The student turns in their assignments on time.

The student listens to and follows directions.

The student’s work is done neatly and they check to make sure it’s their best work.

The student works independently in class and uses their resources correctly.

The student participates 100% every time we “turn and talk” or “talk with our groups.”

The student understands that mistakes are a part of the learning process.

The student controls their talking.

The student works hard everyday.

The student always accept responsibility for their actions.

The student works well with others in their group.

The student works well with others in PE.

The student works well with others at recess.

The student is able to control their emotions and calm-down when feeling strong emotions.

The student always has a positive attitude.

The student will say I’m sorry when they know they have made a mistake.

The student demonstrates self-control.

The student asks for help when they need it.

The student can focus their attention during lessons and at other times when needed.

The student enjoys reading.

The student enjoys math.

The student has learned a lot this school year.

COMMENTS

© 2019 – Anna Monteil

 5th grade mathematics q v j k
The student knows what a growth mindset is.

The student has a growth mindset, they know that their brain can learn anything.

The student understands how to multiply 3-digit numbers by 3 or 4-digit numbers.

The student knows how to divide 3 or 4-digit numbers by 2-digit divisors.

The student understands the difference between a dividend and a divisor.

The student can add and subtract fractions and mixed numbers.

The student knows a fraction is the same as a division problem. 5/8= 5 divided by 8.

The student can multiply a fraction by a fraction and draw model.

The student can turn fractions into decimals.

The student can multiply and divide decimals.

The student passes most of their math tests on the first try.

The student pays attention and participates in all math lessons.

The student gives their best effort when completing math assignments.

The student uses their time wisely during math “work times.”

The student understands almost every math lesson.

reading/writing q v j k
The student reads the entire time during time in text, everyday.

The student pays attention and participates in all reading lessons.

The student gives their best effort when completing reading assignments.

The student reads at home every “school night” for 30 minutes.

The student uses their time wisely during reading “work times.”

The student writes in complete sentences, using capitals & punctuation.

The student spells words correctly in their writing. They use resources to check my spelling.

The student writes in neat legible handwriting.

The student can take well-organized notes on anything they read.

The student understands what they read.

The student can find the main idea of a text.

The student can identify the text structure of a text.

The student can identify the theme of a text.

The student can summarize a story.

The student can determine point of view.

The student can compare and contrast.

The student knows what an opinion essay looks like and how to write one.

The student knows what an informative essay/report looks like and how to write one.

The student knows what a narrative looks like and how to write one.

The student knows what a noun, verb, and adjective are.

© 2019 – Anna Monteil
 mathematics q v j k
I know what a growth mindset is.

I have a growth mindset, I know that my brain can learn anything.

I understand how to multiply 3-digit numbers by 3 or 4-digit numbers.

I know how to divide 3 or 4-digit numbers by 2-digit divisors.

I understand the difference between a dividend and a divisor.

I can add and subtract fractions and mixed numbers.

I know a fraction is the same as a division problem. 5/8= 5 divided by 8.

I can multiply a fraction by a fraction and draw model.

I can turn fractions into decimals and multiply and divide decimals.

I can find the volume of a rectangular prism.

I pass most of my math tests on the first try.

I pay attention and participate in all math lessons.

I give my best effort when completing math assignments.

I use my time wisely during math “work times.”

I understand almost every math lesson.

reading/writing q v j k
I read the entire time during time in text, everyday.

I pay attention and participate in all reading lessons.

I give my best effort when completing reading assignments.

I read at home every “school night” for 30 minutes.

I used my time wisely during reading “work times.”

I write in complete sentences, using capitals & punctuation.

I spell words correctly in my writing. I use resources to check my spelling.

I write in neat legible handwriting.

I can take well-organized notes on anything I read.

I understand what I read.

I can find the main idea of a text.

I can identify the text structure of a text.

I can identify the theme of a text.

I can summarize a story.

I can determine point of view.

I can compare and contrast.

I know what an opinion essay looks like and how to write one.

I know what an informative essay/report looks like and how to write one.

I know what a narrative looks like and how to write one.

I know what a noun, verb, and adjective are.

© 2019 – Anna Monteil
 mathematics q v j k
The student knows what a growth mindset is.

The student has a growth mindset, they know that their brain can learn anything.

The student understands how to multiply 3-digit numbers by 3 or 4-digit numbers.

The student knows how to divide 3 or 4-digit numbers by 2-digit divisors.

The student understands the difference between a dividend and a divisor.

The student can add and subtract fractions and mixed numbers.

The student knows a fraction is the same as a division problem. 5/8= 5 divided by 8.

The student can multiply a fraction by a fraction and draw model.

The student can turn fractions into decimals.

The student can multiply and divide decimals.

The student passes most of their math tests on the first try.

The student pays attention and participates in all math lessons.

The student gives their best effort when completing math assignments.

The student uses their time wisely during math “work times.”

The student understands almost every math lesson.

reading/writing q v j k
The student reads the entire time during time in text, everyday.

The student pays attention and participates in all reading lessons.

The student gives their best effort when completing reading assignments.

The student reads at home every “school night” for 30 minutes.

The student uses their time wisely during reading “work times.”

The student writes in complete sentences, using capitals & punctuation.

The student spells words correctly in their writing. They use resources to check my spelling.

The student writes in neat legible handwriting.

The student can take well-organized notes on anything they read.

The student understands what they read.

The student can find the main idea of a text.

The student can identify the text structure of a text.

The student can identify the theme of a text.

The student can summarize a story.

The student can determine point of view.

The student can compare and contrast.

The student knows what an opinion essay looks like and how to write one.

The student knows what an informative essay/report looks like and how to write one.

The student knows what a narrative looks like and how to write one.

The student knows what a noun, verb, and adjective are.

© 2019 – Anna Monteil
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© TO THE FOURTH & BEYOND - Anna Monteil