Name: ________________Date: ____________Grade: ________________Class: ___________Scholar Reflection Sheet Why was I removed from my class?____________________________________________________________________________________________________________________________________________________________________________________________________I feel. Happy Sad Angry FrustratedNext Time I Will..____________________________________________________________________________________________________________________________________________________________________________________________________Teacher Reflection Form (over)

Summer SHINE Teacher S.R.R. Reflection FormTeacher Name: ________________________Student Name: ________________________Date of Meeting: ______________________Time of Meeting: ______________________Please describe the meeting you had with your scholar (what was said, what was the outcome, what strategies will be used with this student in the future to help prevent this situation from happening again?)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Additional support requested from the teacher:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

This form must be completed and submitted to the Jenna DeNicola by 2:00 on the day student is in SRR

The parent was contacted on ________________ (date) at ________________ (time)