Goal Tracking: ShaKiera Thorpe 1/15/2016

Dear Teachers:

Please fill out this Goal/Behavioral Tracking Survey on ShaKiera Thorpe for 1/15/16.

Please remember you are evaluating her 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 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)

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 these techniques. Please indicate HOW MANY TIME IF IT IS MORE THAN TWICE and which technique they used in the "Other" box.

Please describe the situation below where the student has been or has not been successful in using relaxation techniques.

How many times did the student shout out answers when the expectation was the teacher will call on people?

Any other positive or negative comments about the student in behavior TODAY? (Please indicate if you have seen out of character behavior.)

Any other positive or negative comments about the student in behavior in the last TWO WEEKS? (Please indicate if you have seen out of character behavior.)

Do you wish to speak to me in person?

Yes

Name, Class, Period

Thank you for filling out this survey!