Think, Reflect & Restore

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Student: ___________________________________________ Date: ________________

THINK, REFLECT & RESTORE


Instructions: Complete the following thoroughly and honestly. A copy of this sheet may be given to
each of your teachers, your counselor, 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 our school (i.e. teacher), a friend and/or a family member?

1st step: _________________________________________________________________

Support that is needed: ________________________________________________


Student Name: _______________________________ EXIT REFLECTION
Instructions: 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.
Our goal is to NOT have you return to In-School Suspension. 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 man’s doing but my own. I am the force” (Elaine Maxwell).

My Plan for Improvement

STEP #1
Consequence #1:
Description of My Behavior
Reason I earned this suspension _____________________________ _________________________________
________________________________ _____________________________
_________________________________
________________________________ _____________________________
________________________________ _____________________________ STEP #2
________________________________
Consequence #2: _________________________________
_____________________________
_________________________________
_____________________________

 _____________________________ STEP #3


_____________________________
How has today’s session of In-School _________________________________
Suspension HELPED you?
Consequence #3: _________________________________
___________________________________________ _____________________________

___________________________________________ _____________________________ Name one person, other than you,


_____________________________
___________________________________________ that can SUPPORT you in your Plan for
_____________________________
___________________________________________
Improvement. _____________________
___________________________________________



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