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    How Are You Feeling?

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    api-384812274
    The document is a feelings and behavior reflection form for a student. It has sections for the student to indicate how they are feeling, what behavior issue occurred, and a plan for how to do better next time. The teacher helps the student accurately reflect on their behavior and writes their behavior improvement plan. Then all parties sign agreeing to the reflection and plan.

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    © All Rights Reserved
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    How Are You Feeling?

    Uploaded by

    api-384812274
    108 views3 pages
    The document is a feelings and behavior reflection form for a student. It has sections for the student to indicate how they are feeling, what behavior issue occurred, and a plan for how to do better next time. The teacher helps the student accurately reflect on their behavior and writes their behavior improvement plan. Then all parties sign agreeing to the reflection and plan.

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    The document is a feelings and behavior reflection form for a student. It has sections for the student to indicate how they are feeling, what behavior issue occurred, and a plan for how to do better next time. The teacher helps the student accurately reflect on their behavior and writes their behavior improvement plan. Then all parties sign agreeing to the reflection and plan.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    108 views3 pages

    How Are You Feeling?

    Uploaded by

    api-384812274
    The document is a feelings and behavior reflection form for a student. It has sections for the student to indicate how they are feeling, what behavior issue occurred, and a plan for how to do better next time. The teacher helps the student accurately reflect on their behavior and writes their behavior improvement plan. Then all parties sign agreeing to the reflection and plan.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Name: ______________________________________ Date: _________________

    How are you feeling?

    Scared Angry Sad Worried


    Parent Signature Parent Signature

    What Happened?
    Not on task Not following directions
    Pushing
    Not or hitting
    following directions
    Not using kind words Being disrespectful
    Not using kind words
    Not on task
    Pushing or hitting Not on_____________
    Other: task

    Not using kind words Not following directions


    What will
    Not on taskyou do differently next
    Pushing or hittingtime?
    Not using kind words
    _________________________________________________
    Not on task
    _________________________________________________
    _________________________________________________
    _________________________________________________
    _________________________________________________
    _________________________________________________
    _________________________________________________
    ______________________ _____________________ ______________________
    Teacher Signature Student Signature Parent Signature
    _________________________________________________
    Parent Signature
    _________________________________________________
    Name: ______________________________________ Date: _________________

    How are you feeling?

    Scared Angry Sad Worried


    Parent Signature Parent Signature

    What Happened?
    Not on task Not following directions
    Pushing
    Not or hitting
    following directions
    Not using kind words Being disrespectful
    Not using kind words
    Not on task
    Pushing or hitting Not on_____________
    Other: task

    Not using kind words Not following directions


    What will
    Not on taskyou do differently next
    Pushing or hittingtime?
    Not using kind words
    _________________________________________________
    Next time I feel mad, I will go to the quiet corner and sit until I am feeling better or
    Not on task
    _________________________________________________
    talk to my teacher instead of hitting my friends.

    _________________________________________________
    _________________________________________________
    _________________________________________________
    _________________________________________________
    _________________________________________________
    ______________________ _____________________ ______________________
    Teacher Signature Student Signature Parent/Guardian Signature
    _________________________________________________
    Parent Signature
    _________________________________________________
    The student will color in the face at the top as to how they are feeling. They will then put an X on the box that

    indicates what their behavior was. The teacher will sit down with the student and make sure they marked the correct box

    and help the student to form a plan of action to improve the behavior. The teacher will write the plan of action in the space

    provided for the student. The document will then be signed by the teacher, the student, and their parent/legal guardian.

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