___ Very likely ___ Sometimes ___ Seldom ___ Never 4. What is the likelihood of the student’s resulting in acknowledgment (e.g., reprimands, problem behavior corrections) from teachers or other school staff? ___ Very likely ___ Sometimes ___ Seldom ___ Never 5. What school-related and activities are to the student? What items or activities could most enjoyable serve as special rewards? ___ Social interaction with adults ___ Music ___ Art activity ___ Social interaction with peers ___ Puzzles ___ Computer ___ Playing a game ___ Going outside ___ games ___ Helping teacher ___ Going for a walk ___ Watching TV/video ___ Line leader ___ ___ Objects (Specify) ___________________ ___ Going to media center ___ PE time __________________________________ ___ Sensory activity (specify) ___ Extra free time ___ Food (Specify) _____________________ ____________________ __________________________________ Other(s):_______________________________________________________________________________ Additional comments not addressed above in the Reinforce Component. This page intentionally left blank (because I couldn’t figure out how to delete it) Use it to doodle!
___ Very likely ___ Sometimes ___ Seldom ___ Never 4. What is the likelihood of the student’s problem behavior resulting in acknowledgment (e.g., reprimands, corrections) from teachers or other school staff? ___ Very likely ___ Sometimes ___ Seldom ___ Never 5. What school-related and activities are most enjoyable to the student? What items or activities could serve as special rewards? ___ Social interaction with adults ___ Social interaction with peers ___ Playing a game ___ Helping teacher ___ Line leader ___ Going to media center ___ Sensory activity (specify) ____________________ ___ Music ___ Puzzles ___ Going outside ___ Going for a walk ___ ___ PE time ___ Extra free time ___ Art activity ___ Computer ___ games ___ Watching TV/video ___ Objects (Specify) ___________________ __________________________________ ___ Food (Specify) _____________________ __________________________________ Other(s):_______________________________________________________________________________ Additional comments not addressed above in the Reinforce Component. This page intentionally left blank (because I couldn’t figure out how to delete it) Use it to doodle!
B5_Handout%20packet%20blank%20forms.docx