Student Action Plan

The questions on this sheet will help you think about what just happened, and what can
be done so it doesn’t happen again.

Please answer these questions honestly and with as much detail as possible. Glib or
sarcastic responses will not be accepted. Thank you in advance for your work.

Name____________________________ Date__________ Time__________

1. What did I do that got me into trouble?

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

2. What did I want to happen? (Check all the answers that fit.)
_____ I wanted to be in charge of what was happening.
_____ I wanted to challenge the teacher’s authority.
_____ I wanted to avoid doing my work.
_____ I wanted to get sent out of the room.
_____ I wanted to be noticed by the teacher.
_____ I wanted to be noticed by the other students.
_____ I wanted to get out of work I didn’t think I could do or do correctly.
_____ I wanted to get even with someone.
Is there anything else I wanted?
I wanted ______________________________________________________
____________________________________________________________
____________________________________________________________
3. Did I get what I wanted?
Yes, because ___________________________________________________
____________________________________________________________
No, because ____________________________________________________
____________________________________________________________

4. Could I have gotten what I wanted in any other way?

Yes, I could have ________________________________________________
____________________________________________________________
____________________________________________________________
No, because ____________________________________________________
____________________________________________________________
____________________________________________________________

5. What could I do so this won’t happen again?

I could _______________________________________________________
I could _______________________________________________________
I could _______________________________________________________

6. This is what I am willing to do differently next time:

____________________________________________________________
I will ________________________________________________________
I will ________________________________________________________

7. The name of a person who could help me do what I’m willing to is _____________
(People who might help include a teacher, counselor, family member, or a classmate
who is not my friend.)
The way this person could help me is by _________________________________
____________________________________________________________
8. This is what I could do to feel more capable, more connected, and contribute more
positively:
I would feel more capable if I ________________________________________
____________________________________________________________
I would feel more connected if I ______________________________________
____________________________________________________________
I could contribute positively by _______________________________________
____________________________________________________________

9. Look back at the person in number 7 that you identified who could help you. This
is what this person could do to feel more capable, more connected, and contribute
more positively:
I would feel more capable if he / she ___________________________________
____________________________________________________________
I would feel more connected if he / she _________________________________
____________________________________________________________
I could contribute positively if he / she _________________________________
____________________________________________________________

10. Is there anything else that you would like to share with me? ________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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