Activity A- Reflection and Goal Setting Form

Activity A- Reflection and Goal Setting Form
Student First and Last Name: *
First and Last Name
How are you feeling today?*
1 = Bad2 = Meh3 = OK4 = Good5 = Excellent
Are there any needs that we as a school may supply? Tech support? Emotional support? Other?*
What course are you taking?*
Ex: English 9A, Algebra 1B, World History A
What credit number are you on for that subject?*
1,2,3,4 or 5?
What section or page number are you on?*
Lesson 1,2, or 3 OR Page number
What OTHER Subject are you taking? (if you're not taking another subject please type in "None")*
What OTHER credit number are you on for that subject? (if you're not taking another subject please type in "NA")*
What OTHER section or page number are you on? (if you're not taking another subject please type in "NA")*
We also know setting long-term goals for ourselves, such as learning to speak another language or starting a career, is how we reach them. What is a long-term goal you want to set? OR Is it the same as the last time we met? Has any part of it changed?*
Why is that long-term goal meaningful to you?*
What do you need to achieve your long-term goal?*
Last LP, did you achieve your short term goal?*
YesNo
Why or why not?*
We know that setting short term goals, like finishing all our homework or exercising for an hour, is good for us, so what is a short-term goal (4 weeks) you'd like to set?*
Why is this short-term goal meaningful to you?*
In some Latin-American countries, they celebrate Valentine's day as "el Día del Amor y la Amistad” (Day of Love and Friendship), where significant others receive gifts, as well as family and friends, and become a part of this tradition full of presents, hugs, and/or nice words. Do you have someone in mind to whom you want to give extra love to this month (and yourself can be part of or all of the answer)?*
Should be Empty: