San Francisco Peer Court
Restorative Justice Alternatives for Youth

Parent / Guardian Name

Youth Respondent Name

Your Role

explain your role if you are a support person

Respondent's Interests

Respondent's Strengths and Aptitudes

Negative Impact of this incident on Respondent

Negative impact this incident has had on parents, family members, or others

Positive Impact of this incident on Respondent

What has the Respondent done to repair harm caused by this incident?

Conclusion/ other statements

What does this child like to do in his or her spare time? What activities does this person find interesting, entertaining or worth their time?



At what activities does this child show aptitude or strengths? Any particular subjects in school? Art, music, sports, family responsibilities, community responsibilities, positive or supportive personality traits or relationships, others

This child was referred for a criminal or prohibited behavior. Please describe any negative impact that this incident has had on your child in terms of harmed relationships with family or community, missed school, justice system contact, punishment or any other negative effects

Please describe any positive impact this incident may have had on your child, including improved understanding of the impact of their actions, positive behavioral changes, or any other positive effects that may have resulted

Please describe any actions that your child has already taken to repair harm caused by this incident, including making apologies, returning or repairing property, etc. 

How do you think this issue should be resolved in a way that repairs relationships and community? Is there anything else you would like the Peer Court to consider

STEP 7 - Respondent Support Statement

Family members, friends and other support people for Respondents can use the form below to discuss the strengths and positive characteristics of the person they are trying to support, along with the impact that this incident has had on their lives, and suggestions for a resolution...

Please describe any impact this incident has affected you as a parent or family member, or supporter of the respondent. How has this incident affected you? How has it affected your family? How did you feel when you learned about the incident? How has it impacted your relationship with this child? Have other peers been affected like sports teams or classmates? any other impact you'd like to list

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1. Res. Pre Test
2. Res. Application
3. Res Strengths
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5. Res. Demographics
6. Impact Survey