Computer Misuse and Consequences Form

Name of Student _______________________________

Date ________________      Time _________________

I did not use the computer inappropriately when I ______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________

When I did that, what did I want? _________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

What are 4 other things I could have done?
         1. _________________________________________
         2. _________________________________________
         3. _________________________________________
         4. _________________________________________

What will I choose next time? _______________________
_________________________________________________
_________________________________________________

__________________                  _______________________
            Student                                      Parent (s) Signature

__________________
            Teacher