Burlington High School Freshman Success Team 

Problem Solving Form 

(fill out during meeting and copy for family to take) 
 
Student’s name: Date:  
 
 
Attendees/Roles:  
 
 
 
Grade / Year:   
 
Strengths -  
 
 
Weaknesses / Behaviors (who, what, when, where, why, reactions) -  
 
 
 
Triggers -  
 
 
 
Stresser - (i.e. lack of sleep, substance abuse, family dynamics, medical issues 
etc.) -  
 
 
 
Perceived needs driving behaviors -  
 
 
 
Long term goals (two years after high school) -  
 
 
 
Short term goals -  
 
 
Student’s desired outcomes -  
 
 
 
 
Current Supports -  
 
 
 
 
Possible Solutions -   
 
 
 
 
Follow up process and implementation plan -