Check & Connect High School Monitoring Form
Check & Connect High School Monitoring Form
Student _______________________ ID _____________________________ Grade ________________________ School ________________________ Mentor ________________________ Month _______________________
CHECK
Academic data
M TU W TH
F
M TU W TH
F
M TU W TH
F
M TU W TH
F
High risk
Number of Ds or Fs
Number of missing assignments
Cumulative grades 1st quarter grades 2nd quarter grades 3rd quarter grades 4th quarter grades
____Ds ____Fs
____Ds ____Fs
____Ds ____Fs
____Ds ____Fs
Credit accrual
_____Credits earned out of _____total possible
_____GPA
Met state academic standards Math: o Yes o No
Reading: o Yes o No
Behavior data
M TU W TH F M TU W TH F M TU W TH
Tardy Skipping classes Unexcused/unverified absence Excused absence Behavior referral/infraction
Detention Suspension (in school/out-of-school)
Writing: o Yes o No F M TU W TH F
High risk
CONNECT
Communication
M TU W TH F M TU W TH F M TU W TH F M TU W TH F
Student communication
Formal Informal
Family communication
Attempt/not reached
Left message
Note home
Phone conversation
Meeting
Home visit
Communication with school staff
Communication with outside agency
Basic Intervention
M TU W TH F M TU W TH F M TU W TH F M TU W TH F
Share "check" data Provide regular feedback Discuss staying in school Problem solve about risk
? 2018 Regents of the University of Minnesota. All rights reserved. checkandconnect.umn.edu
Intensive intervention
M TU W TH F M TU W TH F M TU W TH F M TU W TH F
Facilitate goal setting Discuss academic progress and supports
Discuss behavior and supports Discuss how current choices impact likelihood of graduating from high school
Intensive problem solving Intensive problem solving with parent Intensive problem solving with school
personnel Facilitate participation in community service
Facilitate participation in school and community sponsored activities Facilitate tutoring
Facilitate participation in small-group instruction for passing exit exam Teach problem solving skills
Teach organization and study skills Arrange an alternative to suspension Other:
Monthly summary of case notes
Date: Goal: o Attendance o Engagement o Investment in future
Date: Goal: o Attendance o Engagement o Investment in future
Date: Goal: o Attendance o Engagement o Investment in future
Date: Goal: o Attendance o Engagement o Investment in future
Date: Goal: o Attendance o Engagement o Investment in future
Notes: Notes: Notes: Notes: Notes:
? 2018 Regents of the University of Minnesota. All rights reserved. checkandconnect.umn.edu
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