Strategy1 Strategy2 Strategy3
Implementation
Date
BeginDate1 BeginDate2 BeginDate3
Descriptionof
Intervention
DescripIntervention
DescriptIntervention2
DescriptIntervention3
Frequencyof
Intervention
Frequency
Frequency2
Frequency3
Durationof
Intervention
Duration
DurationIntervention2
DurationIntervention3
StaffResponsible
StaffResponsible
StaffResponsible2
StaffResponsible3
Progress
MonitoringTool/
Frequencyof
Progress
Monitoring/
ProgressMonitoring1
ProgressMonitoring2
ProgressMonitoring3
GearyCountyUSD475ExceptionalStudentServicesDivision
123NorthEisenhower-JunctionCity,KS66441
Phone(785)717-4000
Fax(785)717-4002
''
ACTIONPLAN
DATEofInitialActionPlan:ReviewDate
DEMOGRAPHICS
StudentNameStudent'sNameGradeStudent'sGradeDOBStudent'sDOB
TeacherSchool
SMARTGOAL
ConcernArea:Reading/Literacy Math Behavior HighAbility Other
Screener:DATEofscreenermustbestated.
Screener
DiagnosticToolsanddatausedtoaidinidentifyingareaofdeficit.
DiagnosticBaseline
SMARTGoal-Specific,Measurable,Attainable,RealisticandTimely
Objective
INTERVENTION/STRATEGY
GearyCountyUSD475ExceptionalStudentServicesDivision
123NorthEisenhower-JunctionCity,KS66441
Phone(785)717-4000
Fax(785)717-4002
''
INTERVENTIONRESULTS
RESULTS
Strategy1Results
Strategy2Results Strategy3Results
Date PMData
Date PMData
Date PMData
Date1 PMDATA1 Date7 PMDATA7 Date13 PMDATA13
Date2 PMDATA2 Date8 PMDATA8 Date14 PMDATA14
Date3 PMDATA3 Date9 PMDATA9 Date15 PMDATA15
Date4 PMDATA4 Date10 PMDATA10 Date16 PMDATA16
Date5 PMDATA5 Date11 PMDATA11 Date17 PMDATA17
Date6 PMDATA6 Date12 PMDATA12 Date18 PMDATA18
CommentsaboutStrategiesastheyareimplemented.

Comments1
Comments2
Comments3
Interventionsnotassociatedwithgoal:
Comments4
Recommendation:
Tier1 Tier2 Tier3 504Plan ESSReferral Continuestrategy Newstrategy
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