B.R.A.I.N.

- Student Data Collection

Week of ___ / ___ / ___ - ___ / ___ / ___
Student Name: Teacher:

MON
MORNING READING MATH SCI/SOC BEHAVIOR SPECIALS /
GOAL LUNCH RECESS JOURNALING TOTALS
WORK / RTI BLOCK BLOCK BLOCK INTERVENTION ENRICHMENT
SOCIAL
/27 %
DEVELOPMENT
ON-TASK / WORK
/27 %
COMPLETION
SELF REGULATION
%
/27
RESTROOM BREAK
DAILY TOTAL %
/81

TUE
MORNING READING MATH SCI/SOC BEHAVIOR SPECIALS /
GOAL LUNCH RECESS JOURNALING TOTALS
WORK / RTI BLOCK BLOCK BLOCK INTERVENTION ENRICHMENT
SOCIAL
DEVELOPMENT
/27 %
ON-TASK / WORK
COMPLETION
/27 %
SELF REGULATION
/27 %
RESTROOM BREAK
DAILY TOTAL /81 %

WED
MORNING READING MATH SCI/SOC BEHAVIOR SPECIALS /
GOAL LUNCH RECESS JOURNALING TOTALS
WORK / RTI BLOCK BLOCK BLOCK INTERVENTION ENRICHMENT
SOCIAL
/27 %
DEVELOPMENT
ON-TASK / WORK
/27 %
COMPLETION
SELF REGULATION
/27 %
RESTROOM BREAK
DAILY TOTAL /81 %
0 points: did not meet goal  
1 point: unsatisfactory-met goal but required significant redirection/prompting (5 +)       
2 points: satisfactory-met goal, but required some redirection/prompting (1-4 prompts)      
3 points: Exemplary-met goal independently
CONTINUED ON BACK
 B.R.A.I.N. - Student Data Collection
Week of ___ / ___ / ___ - ___ / ___ / ___
Student Name: Teacher:

THU
MORNING READING MATH SCI/SOC BEHAVIOR SPECIALS /
GOAL LUNCH RECESS JOURNALING TOTALS
WORK / RTI BLOCK BLOCK BLOCK INTERVENTION ENRICHMENT
SOCIAL
DEVELOPMENT
/27 %
ON-TASK / WORK
COMPLETION
/27 %
SELF
REGULATION
/27 %
RESTROOM BREAK
DAILY TOTAL /81 %

FRI
MORNING READING MATH SCI/SOC BEHAVIOR SPECIALS /
GOAL LUNCH RECESS JOURNALING TOTALS
WORK / RTI BLOCK BLOCK BLOCK INTERVENTION ENRICHMENT
SOCIAL
DEVELOPMENT
/27 %
ON-TASK / WORK
COMPLETION
/27 %
SELF
REGULATION
/27 %
RESTROOM BREAK
DAILY TOTAL /81 %
0 points: did not meet goal  
1 point: unsatisfactory-met goal but required significant redirection/prompting (5 +)       
2 points: satisfactory-met goal, but required some redirection/prompting (1-4 prompts)      
3 points: Exemplary-met goal independently

NOTES:
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SOCIAL DEVELOPMENT – _______________________________________________________________________________________________________________________________________________________________

ON-TASK / WORK COMPLETION – ________________________________________________________________________________________________________________________________________________________

SELF REGULATION – ___________________________________________________________________________________________________________________________________________________________________