Goal Tracking: Jimmy Johnson 1/15/2016

Dear Teachers:

Please fill out this Goal/Behavioral Tracking Survey on Jimmy Johnson for 1/15/16.

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 1/15/2016. 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)

Did the student use calming techniques (removal from situation, talked to preferred adult, breathing) If so, how many times did this student used techniques. (Please specify which technique was used in the "other" box)

How many prompts did the student need to put away his cell phone and complete or participate in class?

How many prompts did the student need to stop talking?

Any other positive or negative comments about the student in behavior TODAY?

Any other positive or negative comments about the student in behavior in the last TWO WEEKS? (Please indicate any out of character behavior was present)

Do you wish to speak to me in person?

Yes

Name, Class, Period

Thank you for filling out this survey!