This is what they will be filling out:

FORMAL APOLOGY

To:

From:

Statement:

It has come to my attention that action requiring apology could be seen as (offensive, annoying, selfish, hurtful). I never intended to consequence of your action. I want you to understand that I was merely trying to your intention, though I can see now that it may appear that I was perceived motive. Please accept my adjective apology. Moving forward, I will attempt to proposed solution. That said, I would very much appreciate it if you request for other party.

Sincerely, your relationship to person, your name.

SINCERITY: (They will hold the answers here, like you would put a check mark in a box)
(Heartfelt, begrudging, technical)

EXCUSES:
(It is a habit, I am a naturally selfish person, I thought it would be funny, I didn't know it bothered you, you were never supposed to know, I was hungry, lonely, intoxicated, it was my evil twin)

I FEEL:
(Terrible, guilty, stupid, sorry, blameless, vindicated, better now.)

PLEASE:
(Forgive me, be patient with me, give me another chance, forget it ever happened, do not try to get even, do not call the police, do not tell my parents)

ADDITIONAL NOTES:
Additional notes here