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BIP PROGRESS MONITORING (Version 11/6/2018)STUDENT NAME: FORMTEXT ?????STUDENT DOB: FORMTEXT ?????STUDENT ID: FORMTEXT ?????INITIAL BIP DATE: FORMTEXT ?????CHRONOLOGICAL AGE: FORMTEXT ?????DOMINANT LANGUAGE: FORMTEXT ????? ENL? FORMCHECKBOX YES FORMCHECKBOX NOSCHOOL: FORMDROPDOWN FORMTEXT BIP UPDATED: 1) FORMTEXT ?????; 2) FORMTEXT ?????3) FORMTEXT ?????; 4) FORMTEXT ?????5) FORMTEXT ?????; 6) FORMTEXT ?????GRADE: FORMDROPDOWN IS STUDENT CSE IDENTIFIED? FORMCHECKBOX YES FORMCHECKBOX NOIF IDENTIFIED – CLASSIFICATION: FORMTEXT ?????CLASS PLACEMENT: FORMTEXT ????? 504? FORMCHECKBOX YES FORMCHECKBOX NOINDIVIDUALS/STAFF WHO DEVELOPED ORIGINAL BIP DOCUMENT (include title): FORMTEXT ?????CURRENT STAFF RESPONSIBLE FOR BIP IMPLEMENTATION (include title): FORMTEXT ?????Re-state Information Obtained on the Functional Behavior AssessmentTARGET BEHAVIOR: FORMTEXT ????? GOAL BASELINE: FORMTEXT ?????REPLACEMENT BEHAVIOR: FORMTEXT ?????INITIAL BASELINE OF THE TARGET BEHAVIOR: FREQUENCY- How often a behavior occurs- (Indicate if N/A) FORMTEXT ?????DURATION –The length of time a behavior lasts- (Indicate if N/A) FORMTEXT ?????LATENCY –How long it takes for a behavior to begin after a specific stimulus- (Indicate if N/A) FORMTEXT ?????INTENSITY –How severe the behavior is- FORMTEXT ?????HYPOTHESIS FROM THE FBA:WHEN THIS OCCURS (describe the circumstances/setting events) FORMTEXT ?????THE STUDENT DOES (describe the target behavior) FORMTEXT ?????TO GET/AVOID (describe the consequences) FORMTEXT ?????REVIEW 1Baseline Data Update Using Progress Monitoring DataAll Progress Monitoring Data Should Be GraphedDate: FORMTEXT ????? Present: FORMTEXT ????? Data Review Dated From FORMTEXT ????? To FORMTEXT ?????BaselineProgress Monitoring Data Summary for This ReviewChange from Baseline(Increase/Decrease/No Change)Target Behavior: FORMTEXT ?????Frequency: How often a behavior occurs- FORMCHECKBOX Check if Not Applicable FORMCHECKBOX Rate FORMCHECKBOX Partial Interval FORMCHECKBOX Whole Interval FORMCHECKBOX Momentary FORMCHECKBOX Percent of Opportunities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Duration: The length of time a behavior lasts- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Latency: How long it takes for a behavior to begin after a specific stimulus- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Intensity: How severe the behavior is- FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Supplemental Measure: FORMTEXT ????? FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Does this data review indicate a need to update the BIP? FORMCHECKBOX Yes FORMCHECKBOX NoComments/Analysis (Team discussion, updates to BIP and/or student status, intensifying/ fading intervention etc.): FORMTEXT ?????REVIEW 2Baseline Data Update Using Progress Monitoring DataAll Progress Monitoring Data Should Be GraphedDate: FORMTEXT ????? Present: FORMTEXT ????? Data Review Dated From FORMTEXT ????? To FORMTEXT ?????BaselineProgress Monitoring Data Summary for This ReviewChange from Baseline(Increase/Decrease/No Change)Target Behavior: FORMTEXT ?????Frequency: How often a behavior occurs- FORMCHECKBOX Check if Not Applicable FORMCHECKBOX Rate FORMCHECKBOX Partial Interval FORMCHECKBOX Whole Interval FORMCHECKBOX Momentary FORMCHECKBOX Percent of Opportunities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Duration: The length of time a behavior lasts- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Latency: How long it takes for a behavior to begin after a specific stimulus- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Intensity: How severe the behavior is- FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Supplemental Measure: FORMTEXT ????? FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Does this data review indicate a need to update the BIP? FORMCHECKBOX Yes FORMCHECKBOX NoComments/Analysis (Team discussion, updates to BIP and/or student status, intensifying/ fading intervention etc.): FORMTEXT ?????REVIEW 3Baseline Data Update Using Progress Monitoring DataAll Progress Monitoring Data Should Be GraphedDate: FORMTEXT ????? Present: FORMTEXT ????? Data Review Dated From FORMTEXT ????? To FORMTEXT ?????BaselineProgress Monitoring Data Summary for This ReviewChange from Baseline(Increase/Decrease/No Change)Target Behavior: FORMTEXT ?????Frequency: How often a behavior occurs- FORMCHECKBOX Check if Not Applicable FORMCHECKBOX Rate FORMCHECKBOX Partial Interval FORMCHECKBOX Whole Interval FORMCHECKBOX Momentary FORMCHECKBOX Percent of Opportunities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Duration: The length of time a behavior lasts- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Latency: How long it takes for a behavior to begin after a specific stimulus- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Intensity: How severe the behavior is- FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Supplemental Measure: FORMTEXT ????? FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Does this data review indicate a need to update the BIP? FORMCHECKBOX Yes FORMCHECKBOX NoComments/Analysis (Team discussion, updates to BIP and/or student status, intensifying/ fading intervention etc.): FORMTEXT ?????REVIEW 4Baseline Data Update Using Progress Monitoring DataAll Progress Monitoring Data Should Be GraphedDate: FORMTEXT ????? Present: FORMTEXT ????? Data Review Dated From FORMTEXT ????? To FORMTEXT ?????BaselineProgress Monitoring Data Summary for This ReviewChange from Baseline(Increase/Decrease/No Change)Target Behavior: FORMTEXT ?????Frequency: How often a behavior occurs- FORMCHECKBOX Check if Not Applicable FORMCHECKBOX Rate FORMCHECKBOX Partial Interval FORMCHECKBOX Whole Interval FORMCHECKBOX Momentary FORMCHECKBOX Percent of Opportunities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Duration: The length of time a behavior lasts- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Latency: How long it takes for a behavior to begin after a specific stimulus- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Intensity: How severe the behavior is- FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Supplemental Measure: FORMTEXT ????? FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Does this data review indicate a need to update the BIP? FORMCHECKBOX Yes FORMCHECKBOX NoComments/Analysis (Team discussion, updates to BIP and/or student status, intensifying/ fading intervention etc.): FORMTEXT ?????REVIEW 5Baseline Data Update Using Progress Monitoring DataAll Progress Monitoring Data Should Be GraphedDate: FORMTEXT ????? Present: FORMTEXT ????? Data Review Dated From FORMTEXT ????? To FORMTEXT ?????BaselineProgress Monitoring Data Summary for This ReviewChange from Baseline(Increase/Decrease/No Change)Target Behavior: FORMTEXT ?????Frequency: How often a behavior occurs- FORMCHECKBOX Check if Not Applicable FORMCHECKBOX Rate FORMCHECKBOX Partial Interval FORMCHECKBOX Whole Interval FORMCHECKBOX Momentary FORMCHECKBOX Percent of Opportunities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Duration: The length of time a behavior lasts- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Latency: How long it takes for a behavior to begin after a specific stimulus- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Intensity: How severe the behavior is- FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Supplemental Measure: FORMTEXT ????? FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Does this data review indicate a need to update the BIP? FORMCHECKBOX Yes FORMCHECKBOX NoComments/Analysis (Team discussion, updates to BIP and/or student status, intensifying/ fading intervention etc.): FORMTEXT ?????REVIEW 6Baseline Data Update Using Progress Monitoring DataAll Progress Monitoring Data Should Be GraphedDate: FORMTEXT ????? Present: FORMTEXT ????? Data Review Dated From FORMTEXT ????? To FORMTEXT ?????BaselineProgress Monitoring Data Summary for This ReviewChange from Baseline(Increase/Decrease/No Change)Target Behavior: FORMTEXT ?????Frequency: How often a behavior occurs- FORMCHECKBOX Check if Not Applicable FORMCHECKBOX Rate FORMCHECKBOX Partial Interval FORMCHECKBOX Whole Interval FORMCHECKBOX Momentary FORMCHECKBOX Percent of Opportunities FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Duration: The length of time a behavior lasts- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Latency: How long it takes for a behavior to begin after a specific stimulus- FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Intensity: How severe the behavior is- FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Supplemental Measure: FORMTEXT ????? FORMCHECKBOX Check if Not Applicable FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Does this data review indicate a need to update the BIP? FORMCHECKBOX Yes FORMCHECKBOX NoComments/Analysis (Team discussion, updates to BIP and/or student status, intensifying/ fading intervention etc.): FORMTEXT ????? ................
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