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  5. Goal Tracking: Daniel Pounders 1/26/2016
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Exit Survey
 
 
Dear Teachers:

Please fill out this Goal/Behavioral Tracking Survey on Daniel Pounders for 1/27/16.

Please remember you are evaluating him on today's behaviors. This should only take you approximately 5-10 minutes. If you are in a co-taught class, I only need one survey per class.

I created a box to comment on any behaviors (positive or negative) from today and over the last two weeks that need to be addressed.

Your participation in this survey is valuable to track behavioral trends. This data can be used to head off possible behavioral problems along with providing the opportunity to reward good behavior.

Thank you

Mrs. DuRant
 
 
Please rate the student listed above in the following areas for 1/27/2016. 1 being the lowest and 5 being the highest.
Prepared for Class
On Task Behavior
Appropriate Behavior
Peer Relationships
Adult Relationships
Participation
Responded to authority figure appropriately and respectfully
 
 
 
Please explain how the student did or did not respond to authority figure in an appropriate and respectful manner (Refer to Question One, Last Row)
   
 
 
 
* Today, has the student used any type of calming techniques when they needed to? (Examples but not limited to: deep breaths, removal from situation, talked) If so, how many times did this student used techniques. (Please specify which technique was used in the "other" box)
 
Not Needed
 
None
 
Once
 
Other
 
 
Twice
 
 
 
How many prompts did the student need to put away his reader and complete or participate in class?
   
 
 
The student has an organized notebook (or interactive notebook) with his notes and classwork.
Not Applicable Not Acceptable Acceptable Above Expectations
Notebook
Classwork
Other Required Material
 
 
 
Any other positive or negative comments about TODAY'S behavior? (Please note out of character behavior was present)
   
 
 
 
Any other positive or negative comments about behavior from the LAST TWO WEEKS (Please note out of character behavior was present)
   
 
 
 
Do you wish to speak to me in person?
Yes
No
 
 
 
Name, Class, Period
   
 
Thank you for filling out this survey!