STEM LAUNCH Refocus Form

Student Name: _________________________________________________________

Date:_____________________________
Time:________________

Parent Name: ___________________________________Parent Phone

Please complete the form using complete sentences then return it to your
teacher. Remember: Behavior is always a choice.
What behavior are you being asked to think about? (be reflective)
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What caused you to make this choice? (Personal responsibility)
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What problem(s) did your behavior cause for you, your classmates, and your teacher?
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___What 4 Rs trait do you need to work on to make a better choice next time? (Circle
One)
Respect

Responsibility

Resourcefulness

Reflectivity

Teacher Signature:
__________________________________________________________________________________________
_____
Student
Signature:______________________________________________________________________________
___________________
Parent Signature: