Sample Re-Focus Station Worksheet

P.E. RE-FOCUS STATION WORKSHEET

1.  First & Last Name and Student #:  ____________________________

2.  Grade & Classroom Teacher’s Name:  ___________________________

3.  Today’s Date:  _____  /  _____  /  _____

- Describe why you were sent to the refocus station:

What I did was _____________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What I will do differently next time is ____________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Why I should do this _________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

- As you sit-out I want you to watch class and write down 3 examples of classmates making good choices you would like to do next time.

1. _______________________________________________________
_________________________________________________________
2. _______________________________________________________
_________________________________________________________
3. _______________________________________________________
_________________________________________________________


Parent / Guardian Signature:  ________________________