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  5. Goal Tracking: ShaKiera Thorpe 1/4/16 to 1/15/16
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Dear Teachers:

Please fill out this Goal/Behavioral Tracking Survey on ShaKiera Thorpe for the week of 1/4/16 to 1/15/16.

Please remember you are evaluating her on the last two weeks only. This should only take you approximately 5-10 minutes.

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 the last two weeks. 1 being the lowest and 5 being the highest.
* Prepared for Class
* On Task Behavior
* Appropriate Behavior
* Peer Relationships
* Adult Relationships
* Participation
 
 
 
* In the last two weeks, has the student used any type of calming techniques when they needed to? (Examples but not limited to: deep breaths, removal from situation, talked)
Yes
No
 
 
 
If so, how often has this student used these techniques.
 
Daily
 
Weekly
 
Monthly
 
Other
 
 
 
 
Please describe the situation below where the student has been or has not been successful.
   
 
 
 
* Thinking about the last two weeks, the student listed above responds to authoritative request in an appropriate, respectful manner.
 
All The Time
 
75% of the Time
 
50% of the Time
 
25% of the Time
 
None of the Time
 
 
 
Please explain how the student did or did not respond appropriately.
   
 
 
 
Any other positive or negative comments about the student 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
No
 
 
 
Name, Class, Period
   
 
Thank you for filling out this survey!