oR 2 Researched the student's cum. file. IMPORTANT NOTE: uaplete this form using Thank voyl] 9 Contacted parents & received their (Ceachers, counselors, principals, et) 1. Describe be student's sengths interests, andor hobbies, in regards to helping the student to be 2. t fee succesful at school dite, AL tess sense of hurner, 3 Completed interventions on the Creatue , aged alierdzaces “Behaviora/nstructional uv gy : Checklist.” 2 Deseret e's mastery standards, standakized test scores and rofl Capable of masterty (AES Be) lout docs We Complete, Ou ners se grades reflec [ack of effort. Pitas a behaving Pauet vere be doesme vee. Hine Bake decir. Brrrent ancpleti on 3 Desc te concer you tae south sun = Stages wlth vadtrichirect = Dees i$ (ollauthervah wits assi =Hag been dishonest ab tones — Drarecpect fu -to aves batt = Yoes: nok fale resomsi piliy for Wis acting ‘+_‘Have here tes ime when he ahve onc woe ata Be ud a don heer andi silt? 1 25, aha seme fp hin the eam has asd a contrat lp the stadent be saseatal dea cad cet mes adsection, \placke peter 10 5. Have you collaborated with the tudes other tacbrs Encore, Lesning Center, ULE, previous yeas caches et)? Be ‘ata ” ‘Ifyou cite no pias sck thant foe elaring th sudan SATS ‘Ifyou ice yes, what iterations have they found sees when working withthe stale? Pease retum the completed form fo Alex Dob Updates 912-116. Onthe tices “Bshavioaosional Checks” phse mark he ntrcaons which ane hen tl then working th th student 1. Desert he aren) persion of he situation, Paw share Jats, methods of conta the date you notified them ofthe SAT Referral 4+ SEE THE ATTACHED “PARENT QUESTIONNAIRE" WHICH CAN BE USED FOR GATHERING PARENT INPUT. \ duane dtecaanee te&~ no errant Quone dieconnecte emer \aae 49 Lantack macther ) 8. Case Manager Contacted: Ifthe stent son an EP, o $08 pleas share the date that you informed th ease manage about i cadens cao SAT 9, What is yur gealiatringng this sudett SAT? + Ifthe student may be tested for emotanal cancers, the attached “Emotional Pre Referal Teacher Checks” form must be ‘completed part ofthe SAT Refer. + Ifthe student may be texted for atention concert the Vanderbilt Teacher Rating Scale will need tobe completed. Please ask Alex Dobbo provide you with ths form. Avsiqnmenk to tre Behourae Tea) Ve is in Tier Coss, Pe b, \ never > bes at at uneh: Webeo (ikfivaes $ refuses1 DEHAVIORAL/INTERVENTIONAL CHECKLIST Altempled Succes wry aie" ‘ag fofowing Rae | Provide let a pe To aks Motor compares Yr] [Pesce coe that wil the let now when Behavior no ROTTS gor ten seating ehvion atari lana z Fastin Schedule sor work petiole Towed by Bek [Use us for suet o goto Nady care o eae the aro Revie schedule andor teacher assignments of den weeds [Behavior Management [nplemen a psiuverenvorcomeat progam Tmplement school — home cheeks or communication Qaim Gach age) [Develop a behavior atendane contac (atch) Esco lei Stade ites, ad give oppo 10 eps and sare se es eb) sign Fspoeniy, shat fool das or pear ong, sea) appar patkipaon a school or community wiv iieaeabs Tay uppers Review suet and conerense wih sopprt al pret and oS sign anal menor ae) eepsed [Sted inva or rp coang wi sol sma or lem DART ounselor lec) x Zid 4) icl ed 2 adule ancipation in cont raniton or anger nanagemen Up RTS) Refer othe Student Assistnes Team (SAT) =f cuerent | Paricgue i theTier 2 Program (valle a your schoo) $0 Pl [Assign Community Service eer) rk with rtp at risk coordinuo, hook muse or socal worker (Cas) ero cores or woea servic (ele) N atedhrode- parents ing wth pares oi contact or plan wih area N N he i ’STRUCTIONAL INTERVENTIONS. Aiempied (Dues) Siccosr (iN) ‘inion Organiati [Assign seating near the cache an pouive or OT (Tae chacint op sade ri Provide a specie plas fring in asigna evan oy [Gine wdeor vanes sone Fete changing fom one avy he eR L wv Provide a daily schedule of tasks andasignments alana] Santor signe etcook day one iat Conta wpe ZIM N [Setup nobook ocnizaton sytem ie Fanos al agama EAT Coordinator Uplate 912.19(Undersiandingearaing Explain earning epesaions to the talet Dla begining aon Make sore you have tbe dante atenon before beginning 3 Tea, Prewach vorbulay {Gee multiple ptr Vina sory ttle neste ‘Circ thesamber of concep presenta onetime, Chock Tor understanding oT cach Cone feview bey concep reucnly Reduce reaing nari to ade Fay CONS ony, O NBN Ry CSRS [Namber and squcnce vps a task, Tak trough tbe problem saving Sequence ing» frneroni if posible. Have the ster verbalie the sepa she Wom Provide a mode of en product, IN Provide ous, phi organizers, vy guide or Cops of Oates te [Allow for student se tape recorder computers, caleltos and Uitation a weeded stanmnent Completion Review aoent ail vel Mach sign audeor Tove ompare work sped to pears. Reduce signent engin acorandy ecko be sure he wodent Begins work promply daring study ne [Establish ave forthe dnt o we orequst ssiance ive aternave signmeat father Tha ong Wien signe Provide atonal ine to complee asignmens Beak ong aigrient i sal squeal sep, monToa ach Sep For mudy guides, give page numbers where answers ca be ound |For math asigeen se graph pape. Allow eta space Have he Woden Highligh peaion |e. ive one grade for coment ands spare grade Tor speling andlor sje tow toda wo eo ocorect asignnents To improve grade . atime to return othe clasioom (0 somplete afnshed wor (Uae Weekly Repo Cad Provide incenives for bepnning an comping Sienna [SB] ST NSIS Assessment, Grading and Testing [Provide a sty aide or repaaon NK | low oral or sre esting m=} Ie feild |) eee eee ie led ee eee [Bee i sl sone clang ne sro sponse oer eae Bi Foe TT ernit aking the eto improve he pale ral ‘Supports [Assan a pest ele payscd [Prove choot nance (ce Tnng venir double i in rode bere or air shoo ssvance eizi| ‘Omer Please eure completed for 0 Alex Dobbs - SAT Cooninato.: Emotional reefer Teasher Chek a: | a rater BONG oe qs Vesely ‘isisa forced choke fomat Whe you choo citer Ys or Na ach question ado the sev deserts you bave unter commen Jou may sre sth atom comments secon ene ne as oes a coment ied hail crtera he fans ints dua of eke) compe es 1h child as sisi hy sl comlains oan usual dee ety) Has marked headaches, somach or other body complaints vexfio) Child has excessive visits 10 the school nurse (What are the reasons forthe vss? Fill in dhe additional comments Sect). “Theil sibs chen of : a (Diao moody doesnot smile mac, res, 7 often seems peste eG) Child makes comment slr 0 “I hate mel 0 want die” “Theil often scm anxious eG) Chl scons wore lfroccpe falas poor econ or has >evt{o Childs overly concerned about making mistakes, taking tests, F what the other eildren think 4) The chil cessive withdrawal tendencies or MARI unusual oc kills (or bizare) behavior, resid, Trouble making frends is teased, seems lonely, shy, avoids others or seems ese) Tran aking friends sed, ly, shy, avoids othe vex(id Hears or see things others do no, child fantasize or regresses excessively (Ge Doerner other's perspective lr hid ems rin behavior or though doc cen oor ae appa Socal ee Additonal Comments it any foe — _ oo Over 20 Hye Y 0s in bm Prade (Zora) 2 office reterols T Grade (2014-15) Pleas return the compet form 10 Alex Dobbs ~ SAT Coontiaton Update 9.12513THs 7 Student Schedule For es | Patric Henry Nida Schoo ot oe ee Sy sin A SSE a 0 r aa =a ae =a eutitiaima | valeting | wal face eae arses Paar pean ae fe Ee ee TS ners a bes eae for Eleee Ses Ee Siva ee Sus le eter aera anes Seer an eT anes 5 [Eonar Lepage ence rage As [fo argace SES ers epee TSS ars + ee La a Lee fre rs a ams Ets EE a igen ears —— , pemeterr: fianeawe, hg, ieggame lea. — rae reroute — fraracemer oars farars iar fara + [Reommoon finite (Seema Eyota eas co ae ee ee a I fear con reer48.5 Schoo! Distret Grade 06 Report cara at Gp Caledon Maitre § Prin [ceamtiaie —————————F tas a a Sasi ard estate ees Penance ‘en Po Paced =i a [Tis MUSte Lamb BeNOR Goip Celadon [Atos Searag i civ (Sean sro [ih Prey Pasar) The Narer yr Ener & Eni —Sea=—rade 08 Report Card 2019-2014 for Clandanon Datlon “epee TOREE——, (= sane ortenarores E barren rasa arpa Terr | Aiab Concepts Power ay Re | Sines int Prieto (Sconce) cm ‘Tits cone Pome is [Sues cass Pabten (Sc) Zr Man Coney Pern) ci eto rene ze Mah Coney Pv a) TE] [Semester Pats seers) PTD S TT tas ce Pe co sere Gig Colaborton Sores). ys owen WAT TERS ‘Soares GuipColibonen Seve] VT ey Soya teens Seeman [Gere Termaer Src] —— Ere anderen [Scere] — isons) Eero Scone: Parent Questionnaire Directions: Explain tothe parets why you are talking with them and the purpose of SAT. Is very important tha you tell he paterts that hisinfrmaton wil be sac wih he Silene Assistance Team. Pen let the parents know that helshe dows have the ght to not answer any ofthe questions. Petey samen eer ee Current ving situation (Who dosthe stent live with?) 1. Deseribe your sought s strengths interes andor hobbies. 2 Whatconcers you mos abet your sondsught t home andr schoo? 2.Have there bem ines when he ove concers were pot aproblem or our snidaughter st done beter acai, socially, 12? ys, hat seemed 1 sip hiner? 44 What interventions or sateges have helped when dealing with hese concerns in the past? 5. Sethee any heath or mesicalinfrmaton which woud be bepfl forthe choo staf to know about your sondaugte? If yes, please deere this forma, 6. Isthere sything cae which woud be help for ws to haow bout your sondougter? Intervie. Date ofthe Interview Please return te completed form to Alex Bobb - SAT Coordinator Unde 912-13,