Illinois Service Resource Center



Illinois Service Resource Center

Serving deaf/hard of hearing student behavioral needs

A Technical Assistance Center of the Illinois State Board of Education

Main Office Homepage:isrc.us

3444 West Dundee Road Email: isrc@isrc.us

Northbrook, IL 60062

Voice: 847-559-8195 Helpline(Voice/TTY): 800-550-4772

Fax: 847-559-8199 TTY: 847-559-9493

DHH Behavior Support Team Recognition Application

INSTRUCTIONS:

1. To be considered for recognition, complete all fields on this application with your team’s information.

2. Attach required supporting documentation for your team.

3. Submit all completed materials by February 4, 2014 to Illinois Service Resource Center.

4. Teams will be recognized at the ITHI Conference.

CRITERIA:

|Level 1 |Attend at least 2 |Complete DHH Behavior | | | |

| |trainings per year |Support Team Checklist | | | |

|Level 2 |Attend at least 2 |Score 30 or higher on |Team meets at least twice yearly | | |

| |trainings per year |checklist |outside of trainings | | |

|Level 3 |Attend at least 3 |Score 40 or higher on |Team meets |Team presents on behavior | |

| |trainings per year |checklist |quarterly outside |topic at school or coop | |

| | | |of trainings | | |

|Level 4 |Attend all 4 trainings |Score 50 or higher on |Team meets |Team presents on behavior |-BIPs reviewed with |

| |per year |checklist |monthly outside |topic at school or coop |Van Acker criteria |

| | | |of trainings | |-Walk-thru forms are |

| | | | | |utilized |

Recognition Level Applied For: _____ 1 ____ 2 _____ 3 _____ 4

School/ Coop Name: Team Members:

DHH Supervisor/ Administrator:

SUPPORTING DOCUMENTATION ATTACHED:

|Level 1 |Level 3 |

|___ Commitment for Success Agreement |___ Commitment for Success Agreement |

|___ Behavior Team Checklist |___ Behavior Team Checklist |

| |___ List of team meeting dates |

| |___ Agenda or ppt of presentation |

|Level 2 |Level 4 |

|___ Commitment for Success Agreement |___ Commitment for Success Agreement |

|___ Behavior Team Checklist |___ Behavior Team Checklist |

|___ List of team meeting dates |___ List of team meeting dates |

| |___ Agenda or ppt of presentation |

| |___ Sample BIP with Van Acker Checklist |

| |___ Description of process for utilizing walk-thru form |

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