BEHAVIOR SUPPORT PLAN
for Behavior Interfering with Learning of Student or Peers
Behavior impeding learning is ________________________________________________________
It impedes learning because __________________________________________________________
Team estimate of need for behavior plan: (write plan date in space)
_____extreme _____serious _____moderate _____needing attention, early stage intervention
Current Frequency/Intensity/Duration of Behavior ________________
Any current predictors for behavior? __________________________________________________
Team believes behavior occurs because (team hypothesis-behavior function) __________________
What team believes student should do instead of this behavior (match to hypothesis) _________________________________________________________________________________
Behavior Goals/Objectives related to this plan:
________________________________________________________________________________
Teaching strategies and necessary curriculum or materials for new behavior instruction
________________________________________________________________________________
By Whom?_______________
How Frequent? ____________
Environmental structure and supports to be provided (time/space/materials/interactions)
________________________________________________________________________________
Who establishes? ____________
Who monitors? _______________
Reinforcement procedures
_____________________________
By Whom? ____________
How Frequent? _____________
How to respond or react if behavior occurs again
________________________________________________________________________________
Process for communicating student progress to parents/student and reviewing this behavior plan (Daily/weekly reports/record keeping)
________________________________________________________________________________
Parent signature _____________________________ Student signature ______________________
Team leader F. Samson Administrator _________________________
Other team members present
________________________________________________________________________________
Form revised 9/21/00