Student: ___________________________________________ Date: ________________

Think, reflect and restore

Instructions: Complete the following thoroughly and honestly. A copy of this sheet may be given to each
of your teachers, the assistant principal and/or your parents. Fill every line!

1.)

Describe, in detail, what you did to earn this suspension: _________________

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2.)

What school rule or expectation did you break or violate?

______________________________________________________________________________

3.)

How do you feel about your behavior and actions?

______________________________________________________________________________
______________________________________________________________________________

4.)

My behavior affected (name a person other than YOU)

Examples: teacher, parent, friend, students, administration _____________ by
(explain what the effect was) _________________________________________________
______________________________________________________________________________
______________________________________________________________________________

5.)

What will you do to make things right?

To make things right _________________________________________________________
____________________________________________________________________________________

6.)

What is the first step to solve this problem? What type of support do you
need from this school, a friend and/or a family member?
1st step: _________________________________________________________________
Resource that is needed: ________________________________________________

Student N ame: _____________________________________________

EXIT REFLECTION
I nstructions: At the beginning of the session you completed the Think Sheet, now it is time to reflect upon today and make a plan for
improvement. O ur goal is to N O T have you return to PAWS. We are here to help you be a successful student that shows positive
character. Let me leave you with these words, Whether I fail or succeed shall be no mans doing but my own. I am the force ( Elaine
M axwell) .

My Plan for Improvement

Description of My Behavior
__________________________________
__________________________________
__________________________________
__________________________________

Consequence #1:
_____________________________
_____________________________

STEP #1
_________________________________
_________________________________

_____________________________
_____________________________

STEP #2

Consequence #2:
_____________________________

_________________________________

How has todays session in

In-School Suspension HELPED you?

_____________________________

___________________________________________

_____________________________

___________________________________________

_____________________________

___________________________________________

_________________________________
STEP #3
_________________________________
_________________________________

___________________________________________

Consequence #3:
_____________________________

___________________________________________

_____________________________

Name one person, other than you, that

___________________________________________

_____________________________

can SUPPORT you in your Plan for

_____________________________

Improvement. _____________________