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Behavior Support Plan PDF
Behavior Support Plan PDF
Behavior Support Plan PDF
Student I
Student I is a 6th grader who is 11 years old. He has a specific learning disability that
affects his ability to access the general education curriculum in reading and math. He reads at
about a 2nd grade reading level and is working on multiplication in his math intervention group.
He attends a public school, Strong Middle School, and spends 4 periods (hours) of the day in the
general education classroom and 2 periods (hours) a day in intervention groups, one of which is
ran by the special education teacher. When Student I is given a difficult task, demand, or request,
Student I will be off task by playing with an object or be inactive, or be non-compliant in order
to self-stimulate.
Behavioral Support Plan
(Dont forget to use pseudonyms!)
Student:___Student I___________
Grade______6th Grade_____________
Problem Behavior(s)
The major behavior of concern for Student I is the number of times he is off-task during
class academic class periods. Student I is off-task by playing with objects 5-10 times in a one
hour-long class period. The child is off-task by being in active where the student looks around
the room and does not have their eyes on their paper or the teacher, 3-8 times during a one-hour
class period. Student I is non-compliant by not responding to requests, demands, or directions 35 times during a one-hour class period.
Functional assessment strategies Implemented
File Review:
__X_Yes (Date: _________)
Interviews:
__X__Teacher Interview
____Parent/Guardian Interview
Observations:
____No
____Student Interview
____Other__________________
Answer the
teachers with the
class?
Track while
reading?
Keep my eyes on
the task?
Overall?
4th Reading
Intervention
5th Period
Math Core
Teacher:
_________
Teacher:
_________
Teacher:
_________
Teacher:
_________
Teacher:
_________
1 _____
1 _____
1 _____
1 _____
1 _____
2 _____
2 _____
2 _____
2 _____
2 _____
3 _____
3 _____
3 _____
3 _____
3 _____
1 _____
1 _____
1 _____
1 _____
1 _____
2 _____
2 _____
2 _____
2 _____
2 _____
3 _____
3 _____
3 _____
3 _____
3 _____
1 _____
1 _____
1 _____
1 _____
1 _____
2 _____
2 _____
2 _____
2 _____
2 _____
3 _____
3 _____
3 _____
3 _____
3 _____
1 _____
1 _____
1 _____
1 _____
1 _____
2 _____
2 _____
2 _____
2 _____
2 _____
3 _____
3 _____
3 _____
3 _____
3 _____
Self-Monitoring Sheet
Student Name:
Date:
Daily Goal:
Daily Feedback/Comments:
LRBI Approvals (Briefly describe what level of approvals (e.g., basic parent notification,
parental approval, district/state committee approval), if any, would be needed for
the procedures that you have described above, according to the state LRBI
guidelines).
No
No
No
No
No
No
No
No
No
No
No
Responsibilities
Mr. Special
Mr. General