U ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ Ñ ‚ ‹ : SAMPLE STUDENT IMPROVEMENT PLAN Student: Date of Referral:____________________________ Teacher: Grade:____________________________________ Initial Plan:______  Revised Plan:_________________ SIT Case Leader:___________________________ Strengths and Problem Identification Assets: Concerns: What is the specific concern selected for intervention? For the next * hypothesis, __________________, generate interventions (Domain) Possible Interventions Who/When/Supports 1. Classroom Intervention Plan Page 2 of 2 Responding to Problem Behavior (system for dealing with students who don’t follow rules and procedures) 1. Decide who is responsible, when it will happen, and supports necessary to make it work. Modify Monitoring? í ï * � » 4. Revisit: Continue as is? Team Determination: Is the student making adequate progress?_______yes_______no Team Discussion: What does and does not appear to be working with this intervention? h8wı CJ h8wı 6�>* CJ OJ QJ h8wı 5�>* CJ OJ QJ h8wı >* CJ OJ QJ h8wı >* B*CJ OJ QJ ph h8wı 5�CJ OJ QJ &. Parent contact All instruction is designed to assist students in meetingthe New YorR State Learning Standards. Title: SAMPLE STUDENT IMPROVEMENT PLAN Author: Lindak Created Date: 11/1/2008 10:13:00 PM Company: nekesc Other titles: SAMPLE STUDENT IMPROVEMENT PLAN 2. d Expected Outcome Based upon the student’s current performance and known peer performance, in ______weeks, how will this student look? Circle the intervention(s) that have a good chance of working and are manageable. 4. :_____________________________________________ Most students are: This student is: Problem Analysis (Remember: Instruction, Curriculum, Environment, Learner) “We think (insert concern) is occurring because (potential hypothesis)” Which hypotheses seem most likely? : CHANGES TO MONITORING PLAN? If it was not, determine why and adjust plan accordingly. For the next * hypothesis, __________________, generate interventions (Domain) Possible Interventions Who/When/Supports 1. 4. Implement or execute the behavioral plan for 2–4 weeks.

What will the student be doing? If it was, reaffirm hypothesis and either select a new intervention or adjust current intervention. h8wı CJ h8wı >* B*CJ OJ QJ ph h8wı >* CJ OJ QJ !h8wı 5�>* B*CJ OJ QJ ph h8wı >* OJ QJ Once you have created a unique academic intervention plan, you can download the plan in text or PDF format and even email it to others. (If actions are needed prior to interventions, list and determine who is responsible).

How will we monitor progress toward this outcome? ‚ ‚ Å Å Å Å Å ÿÿÿÿ Ù Ù Ù Ù õ 4 Ù U d ) ) ) ) ) ø ú ú ú ú ú ú ¹ ¢ [ v ú Å ú Å Å ) ) Û À À À Å ) Å ) ø À ø À À À ) ÿÿÿÿ €(„o Ù ² À ä % 0 U À Ñ ¶ Ñ À Ñ Å À $ À ú ú ¶ Restate expectation (verbal reprimand/correction) 2. (what/how often) Next meeting to review progress will be. Team Action: Go to Action 2. 3. Action 2: Ask or summarize the teacher/student/or family perception of progress. Interventions are intended toassist students who are atriSR for notachieving the New At Follow-up Action 1: Look at graphed progress monitoring data. And
It is also important to give everyone in the meeting copies of the behavioral plan as well as having them sign the plan. Intervention Ideas and Selection  For the first * hypothesis, __________________, generate interventions (Domain) Possible Interventions Who/When/Supports 1. Academic Intervention Services are intended tosupplement, notreplace, instruction provide bythegeneral curriculum and the regular education teacher. 2.

academic intervention and to develop customized intervention plans for struggling students. Team Action: Based on Action 1 and 2, if Team determines that progress is adequate, make sure plan reflects what is being done. 2. Team Recommendation  ______ End   ______ Maintain ______ Revision (Follow-up ____/____/____) CHANGES TO INTERVENTION PLAN: WHO/WHEN (1) (1) (2) (2) (3) (3) CHANGES TO EXPECTED OUTCOMES? Loss of class privileges for day 3. $ % & H I � ˜   ¡ é ê 0 e m r s ã ä å + \ d e f × Ø ‚ ƒ „ ôäÙÌÙäÙÌ¿ä¹°ŸÌ”Ù„Ù”~nä„äÙ”Ùcnä„äÙ”Ùn”Ù h8wı >* CJ OJ QJ h8wı >* B*CJ OJ QJ ph 3. 3.

Given what you know, does this make sense? Place an * next to them. If Team determines that progress is not adequate: Insure intervention was implemented as planned. Modify Supports? Lose opportunity to participate in weekly drawing 3. : !

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