Refocus Form Name ____________________________________________________________________________ Date ______________________ Teacher _____________________________ Please think about what caused you to be removed from class and write in the spaces provided. I made some choices today that caused me to be removed from the rest of the class. I accept responsibility for my behavior. Here are the choices that I made: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Here are some ideas I have for how to behave differently the next time that I am in a similar situation. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ When you have completed these two sections, and feel ready to return to class, you may: 1. Turn this paper over on the table 2. Wait for the teacher to invite you to return to your seat Refocus Form Name ____________________________________________________________________________ Date ______________________ Teacher _____________________________ Please think about what caused you to be removed from class and write in the spaces provided. I made some choices today that caused me to be removed from the rest of the class. I accept responsibility for my behavior. Here are the choices that I made: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Here are some ideas I have for how to behave differently the next time that I am in a similar situation. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ When you have completed these two sections, and feel ready to return to class, you may: 1. Turn this paper over on the table 2. Wait for the teacher to invite you to return to your seat I have decided to change my behavior; I am ready to return to class. I have decided to change my behavior; I am ready to return to class.
