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Reflective Feedback Form for Courageous Conversation – August 31, 2004

Your School’s Name: _____________________________________
(Note: Please complete and return this form to your principal.)

1. What is your new learning for today?


2. How will today’s work change your practice?


3. How will your work today impact student achievement?


4. How will you know what you did worked?


(over, please)
5. Rate engagement on a scale of 1 to 5 (5 is high)

a. Your own engagement: 1 2 3 4 5
b. Your colleagues’ engagement: 1 2 3 4 5


6. What are the next steps that you, your department, your grade level and your school should take?


7. I wonder……………..

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