Student Action Plan

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Student Action Plan

Student Name_____________________________________________

Grade ___________

Advisory Teacher __________________________________________

Date ____________

Areas of Concern:
Academic
Attendance
Behavior
What are the concerns? (Include any data showing concerns)
_____________________________________________________________________________________
_____________________________________________________________________________________
Student Strengths
What does the student do well?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Goals
What do we hope to accomplish? What behaviors do we hope to change?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Planned Interventions
What will the student commit to?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
How will teachers/staff support these goals?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
How will parents/guardians support these goals?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Progress Monitoring
How and when will we evaluate if the plan is working?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Student Signature: _____________________________________
Teachers/Staff Signature: ____________________
Signature: __________________

Parent/Guardian

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