Michigan City Area Schools BEHAVIOR CONTRACT Student: _______________________Date:__/__/__Grade:____ School: _________________________ Behavior Contract written: ___/___/___ Behavior Contract reviewed: ___/___/___, ___/___/___, ___/___/___, __/___/___ Review Fact Finding Worksheets: Identifying Environmental Factors and Functional Factors What is the behavioral skill deficit of main concern? What are the contributing environmental factors(s)? What are the contributing functional factors(s)? Write student goal: Goal Option 1: Increase Positive Behavior By When Who Will DO what At what level Under what Measured by (student) of proficiency conditions whom and how Goal Option 2: Decrease Problem Behavior By When Who Will NOT DO At what level Under what Measured by (student) what of proficiency conditions whom and how Sample Goal and Plan to Increase a Positive Behavior By April 15, 2015, Dawn will use the skill of Working with Others at 75% proficiency every time group participation is required as measured by Dawn and the teacher on her daily progress. – Assign an adult mentor: □ Counselor/teacher will introduce Dawn to the progress monitoring system-one time □ Homeroom teacher will provide Dawn with progress monitoring cards daily □ – Teachers will assist Dawn in completing the progress monitoring cards daily □ – Dawn will drop off her progress monitoring card at the counselor’s office at the end of each day. □ Mentor and Dawn will meet to discuss progress weekly □ – The team will meet on ____________ to discuss progress towards goal. □ Signatures of all involved:
Michigan City Area Schools BEHAVIOR CONTRACT Student: _______________________Date:__/__/__Grade:____ School: _________________________ Behavior Contract written: ___/___/___ Behavior Contract reviewed: ___/___/___, ___/___/___, ___/___/___, __/___/___ Review Fact Finding Worksheets: Identifying Environmental Factors and Functional Factors What is the behavioral skill deficit of main concern? What are the contributing environmental factors(s)? What are the contributing functional factors(s)? Write student goal: Goal Option 1: Increase Positive Behavior By When Who (student) Will DO what At what level of proficiency Under what conditions Measured by whom and how Goal Option 2: Decrease Problem Behavior By When Who (student) Will NOT DO what At what level of proficiency Under what conditions Measured by whom and how Sample Goal and Plan to Increase a Positive Behavior By April 15, 2015, Dawn will use the skill of Working with Others at 75% proficiency every time group participation is required – as measured by Dawn and the teacher on her daily progress. □ Assign an adult mentor: □ Counselor/teacher will introduce Dawn to the progress monitoring system-one time □ Homeroom teacher will provide Dawn with progress monitoring cards – daily □ Teachers will assist Dawn in completing the progress monitoring cards – daily □ Dawn will drop off her progress monitoring card at the counselor’s office at the end of each day. □ Mentor and Dawn will meet to discuss progress – weekly □ The team will meet on ____________ to discuss progress towards goal. Signatures of all involved: