Self-discipline

Do you wait until the last day to start your homework? yes no
Do you wait until the day homework is due to ask questions? yes no
Do you fail to assign time to study for quizzes the night before? yes no
Do you wait until the last day to cram for tests? yes no
Do you talk while the teacher or another student is talking? yes no
Do you have problems paying attention in class? yes no
Do you find yourself doing just enough to get by? yes no
Do you make being late to class a habit? yes no

Responsibility

Do you routinely forget about assignments and not turn them in? yes no
Do you forget to follow up on any missed material after an absence? yes no
Do you routinely forget to bring the proper materials to class? yes no
Do you make excuses for mistakes instead of admitting them? yes no

Independence in Learning

Do you give up easily when faced with a challenging homework problem? yes no
Do you ask the teacher for help right after you read a challenging problem? yes no
Do you rely more on the teacher as opposed to written instructions? yes no
Do you prefer to ask the teacher questions that you could look up yourself? yes no

Your goal this year will be to improve every question that you answered yes. You must include a way in which you plan to improve a certain area. For instance, if you said yes to routinely forgetting about assignments and not turning them in, your goal could be to utilize the homework journal in your notebook, and check it every day after school to remind you what is due and when. In other words, you cannot simply write, “I will not forget assignments.” You must include an intervention! Write your goals for every “yes” question using the back of this sheet if you run out of room. Share these with a parent and have them sign this with you.

  Goals: After writing the goals, pick three that you will focus on to start the school year. Make sure these are major bad habits. In other words, don’t choose bringing materials to class over not turning assignments in. I would rather you turn all assignments in over always remembering to bring your calculator!

Signed
Student:                               Parent:                               date: