STUDENT TEACHER/INTERN INTERVENTION PLAN (STIP) Student Teacher/Intern Name: _________________________ Date: ______________ Supervising Practitioner OR Administrator (Intern only) Name: ________________________________________ Program Supervisor Name: __________________________ Post Bacc. OR Intern (circle one) Area(s) of Action to be Student/Intern Supervising Program Timeline for Next Steps Improvement Taken Responsibility Practitioner Supervisor Implementation Responsibility Responsibility ___________________________ ___________________________ ___________________________ Student Teacher Signature Supervising Practitioner Signature Program Supervisor Signature
STUDENT TEACHER/INTERN INTERVENTION PLAN (STIP) Student Teacher/Intern Name: _________________________ Date: ______________ Supervising Practitioner OR Administrator (Intern only) Name: ________________________________________ Program Supervisor Name: __________________________ Post Bacc. OR Intern (circle one) Area(s) of Improvement Action to be Taken Student/Intern Responsibility Supervising Practitioner Responsibility Program Supervisor Responsibility Timeline for Implementation Next Steps ___________________________ ___________________________ ___________________________ Student Teacher Signature Supervising Practitioner Signature Program Supervisor Signature
Student%20Teachng%20Intervention%20Plan-STIP.docx