LEARNING BEHAVIORS CHECKLIST Tier 1 Form Student Name: | Date: [Grade Level: [Teacher: *Please check the behaviors impacting academic performance.* READING _— Does not comprehend what is read = Does not finish assignments due to reading difficulty _— Does not use word attack skills —— Omits, adds, substitutes, or reverses letters, words, Or sounds when reading Additional Information: WRITING Unable to copy letters, words, sentences, and Numbers from a model _— Reverses letters and Numbers — Does not Compose complete sentences or express complete thoughts in writing _— Does not organize writing activities —— Unable to copy simple designs ‘Additional Information MATHEMATICAL CALCULATIONS/CONCEPTS _— Does not understand abstract concepts — Falls to correctly solve (+/-*) problems — Does not know/remember facts — Has difficulty solving math word problems Additional Information: SPEAKING ___ Had difficulty imitating speech sounds = bistorts or mispronounces sounds/words = Not fluent when speaking = Does not complete thoughts when speaking — Has a limited speaking vocabulary ‘Additional Information: SPELLING ___ Has difficulty with phonetic approaches = omits, substitutes, adds, or rearranges letters or sounds when spelling __ Requires continued drill and practice to learn Spelling words Additional Information: LISTENING _— Does not follow verbal directions = Has difficulty differentiating speech sounds heard = Requires eye contact in order to listen successfully Additional Information: MEMORY/ORGANIZATION _— Disorganized — Limited memory skils VISUAL/AUDITORY — Requires slow, sequential, presentation of directions/concepts ___ Inconsistent learning behaviors ‘Additional Information: ATTENTION — Has difficulty staying on task — Doesn't complete task before moving on to another __ Begins work impulsively without direction __ Easily distracted Additional Information INTERPERSONAL RELATIONSHIPS Has little or no interaction with teachers MOTIVATION/EMOTIONS ‘Avoids situations, assignments, and responsibilities_— Has little or no interaction with peers — Bothers other students —— Cannot work appropriately in small groups —— Touches other inappropriately in small groups Appears to always be the victim ‘Additional Information: ——Tanores consequences of behavior — Does not appear to care about academic performances Easily agitated/hostile “Does not take responsibilty for actions Additional Information Interventions/Modifications Attempted What strategies were tried to correct the behavior? Please indicate the date on which the strategy was initiated and terminated, how data was gathered, and the outcome achieved by use of the strategy. ENVIRONMENTAL STRATEGIES INITIATED __ Preferential seating = small group instruction Individual instruction = Learning centers Seating among well focused students = Provide student extra or secluded work space Other: ORGANIZATIONAL STRATEGIES __ Time limits for assignments — Frequent questioning to help focus on important information __Allowing additional time to complete task/take test _— Organizing a notebook or providing folder to help organize work _ Asking student to repeat back Directions given _— Highlighting main facts = Assignments are always posted as well as given orally _— Parents intial homework — Assignment checklist or calendar provided for student _— End of day clarification of homework — End of day clarification of homework Not turned in Other: MOTIVATIONAL STRATEGIES _— Sending home daily/weekly progress reports: DATE HOW DATA IS TERMINATED COLLECTED AND RESULTS OF DATA.__ Immediate reinforcement of student's Progress _— Keeping graphs and charts of student's progress __ Conferencing with student’s parents — Increased parent contact (e.g. phone, email, notes home) __ Conferencing with student’s other teachers __ Student reading lesson to aide, peer Tutor, or teacher _— Regular feedback and progress check Within an assignment __ Emphasize correct answer rather than marking incorrect answers ___ Reward system: — Other: PRESENTATION STRATEGIES _— Giving assignments/directions orally and visually _— Allowing oral responses when others are giving written responses. _— Recording directions/lessons so student can listen repeatedly _— Immediate reinforcement of correct response __ Allowing student to have sample or practice test — Relate topics to previous learning and “real world” __ Use of a scribe Allow students have tests orally read — Other: CURRICULUM STRATEGIES _— Special materials (books, MP3 player, language master, manipulatives, calculator, computer. etc.) _ Providing opportunities for extra drill (Lexia, Think Central, reading series, etc.) _— Providing study guide (word lists, outlines, optional projects, etc.) _— Reducing quantity of material — Providing instructional materials ‘geared to students level of basic skills __ Modification of assignments —— Memory strategies Other: BEHAVIOR STRATEGIES. —— Communication between school and home — Behavior system in class (e.g. positive behavior, CHAMPS, SLANT, BEAR)— Affective education — Skills streaming Five clear-cut communicated rules — Immediate consequences — Fast pace and consistent routine — Additional responsibilities = Discuss problem/solutions with peers/grade level staff ____ Establish rapport with student Student contract = Change student groupings, seating = Consult with SPED teacher/school psychologist/other staff members _— Private, personal cuing and signals used with a student _— Opportunities to work cooperatively with another student or small group — Other: ALTERNATE PROGRAM STRATEGIES ___ Interventionist (math, reading, speech, ‘OT/PT) _— One-on-one/small group assistance from staff member Title T = Parent volunteers = Conferencing with school psychologist/school nurse — Community resources = Other: OTHER STRATEGIES Signature/Date