WHAT DID I WANT - Georgia Department of Education
WHAT DID I WANT?
FORM
STUDENT NAME: DATE:
1. DESCRIBE YOUR BEHAVIOR:
2. WHAT DID YOU WANT WHEN YOU WERE DOING THIS BEHAVIOR? (check one or more)
I just feel very mad about being in school today.
Something at home is bothering me.
I wanted attention from others.
I wanted to be in control and not let others control me.
I wanted to show the teacher that I get mad at him/her being in charge.
I just didn’t want to do my work.
I wanted to go home.
I just feel miserable inside.
I’m confused about how I feel.
I’m mad because no one seems to like me.
I wanted revenge.
I feel embarrassed about not understanding my work.
I wanted
3. DID THINGS END UP THE WAY YOU WANTED? YES
NO
4. WHAT WOULD YOU LIKE TO DO DIFFERENTLY NOW OR NEXT TIME?
5. WILL YOU BE ABLE TO CHANGE THIS BEHAVIOR? YES
NO
STUDENT SIGNATURE:
TEACHER SIGNATURE:
................
................
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