The student was placed in time out from the computer lab and must fill out a form to reflect on their behavior and make a plan for improvement. The form requires the student to write down the reason for being placed in time out, their plan to improve, any comments, and what they would like to do in the computer class going forward.

1. Time Out Record
Name:
Class:
Date:
I have been removed from my computer seat. I need to think about why I am in
Time Out, and I must complete a form to help me improve my behavior in the
computer lab.
Reason for placement in Time Out:
My plan for improvement:
My comments:
What I would like to do in computer class: