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Positive Behavior Support for ALL Michigan ... - Oakland Schools

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Worksheet 3.3 Sample <strong>Support</strong> Team Report<br />

Sample <strong>Support</strong> Team Report<br />

Date:<br />

Student’s Name:<br />

Grade:<br />

School:<br />

Program:<br />

Teacher:<br />

Parent Invited: (When): (By Whom):<br />

Conference type:<br />

Initial 1st 2nd 3rd 4th<br />

Meeting Follow-up Follow-up Follow-up Follow-up<br />

Concerns:<br />

Target <strong>Behavior</strong>:<br />

Progress (circle one):<br />

1. Program goals met<br />

2. <strong>Behavior</strong> showing improvement<br />

3. <strong>Behavior</strong> inconsistent<br />

4. No documentable behavior change<br />

5. <strong>Behavior</strong> worsening<br />

Mutually agreed upon strategy:<br />

Conferring team members and titles:<br />

1. 2.<br />

3. 4.<br />

5. 6.<br />

Disposition: ❑ Continue present strategy ❑ Revise strategy ❑ Case closed<br />

Copy distribution: ❑ Team members ❑ Principal ❑ Administrator(s)<br />

❑ Parent<br />

❑ Student<br />

Section 3 – 8

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