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Arctic 7 Behavior Google Form 2019-20
PACK Behavior Reflection Form
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* Indicates required question
Email
*
Your email
Name (Last, First)
*
Your answer
Date
*
Your answer
Period
*
1
2
3
4
5
Enrichment
6
7
Passing Period (in between classes)
Required
Which PACK behaviors were not followed?
*
Prepared - walking into classroom appropriately
Prepared - on time for class
Actively Engaged - on task behavior
Cooperative - not being disruptive to others/learning environment
Cooperative - follow teacher directions
Kind and Safe - being respectful of other people/property
Kind and Safe - being respectful of school property
Kind and Safe - behavior is respectful to staff and/or classmates
Required
In your own words, describe your behavior that led to this action.
*
Your answer
Describe how your behavior affected the learning environment of yourself and other students.
*
Your answer
Explain the actions you will take to correct this behavior in the future.
*
(Is there anything the teacher can do to help you in this area?)
Your answer
Explain one instance in which you have demonstrated that particular PACK behavior well in the past seven days.
*
Your answer
Send me a copy of my responses.
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