ࡱ> :<9` "bjbj 4(bdd4rZ Z Z Z 5 U  XKMMMMMM$hq9Y 5 5 Y Y qZ Z Y "Z Z KY KZ  c$g{ \0, j Y Y Y Y Y Y Y qq Y Y Y Y Y Y Y $$H` TEACHER INTERVIEW  Student s Name:  FORMTEXT      SSN:  FORMTEXT      Grade:  FORMTEXT      Teacher:  FORMTEXT      School:  FORMTEXT      Date:  FORMTEXT       What specific behaviors occur in school that interfere most with this student s learning/social relationships? (Describe the ACTUAL behavior. For example, instead of  aggressive , use  hits ,  kicks ,  trips others , etc.)  FORMTEXT       When are these behaviors most likely to occur?  FORMTEXT       Are there certain persons, events, or situations that consistently trigger the onset of these behaviors?  FORMTEXT       Student s strengths: Academic:  FORMTEXT       Social:  FORMTEXT       Student s weaknesses: Academic:  FORMTEXT   "$&(FHJ^`blnxz|øø}qld`Udjh@aUhAjhAU hA5h?h5CJaJ hbUhjhbUhQ^U jhbUh?UmHnHuj6hbUhQ^U hbUh?jhbUh?UhbUh?5hbUh5h5CJ aJ jh?h?5CJ UaJ hx5CJ aJ hA5CJ aJ $(p o~kd4$$IfTl0) ' t00*644 laT $Ifgd$a$gd"       " $ & ( < > @ J L N V X Z \ p r t ~ d B H ʿΨwrk hAhA hX5jh@aU jhbUh?UmHnHujJhbUhQ^U hbUh?jhbUh?Uh?h5CJaJj@h@aUhAhbUh?5hbUh5 hA5 hbUhjhAUjhAUmHnHu'  N ww $Ifgd~kd$$IfTl0) ' t00*644 laT r Hx !8""{ssssssssss & FgdAgd~kdB$$IfTl0) ' t00*644 laT H J ^ ` b l n r $ 6 : < P R T ^ ` d r v x 𵺛}k}#j:h@ah@aCJUaJh@ahA5CJaJ#jh@ah@aCJUaJh@ahA5#jNh@ah@aCJUaJ hA5hA(jh@ahACJUaJmHnHu#jh@ah@aCJUaJh@ahACJaJjh@ahACJUaJ'   468BD|~ĸޭəĸޭޭuk[j hAh@a5UjhA5U#j h@ah@aCJUaJ#j h@ah@aCJUaJU#j& h@ah@aCJUaJh@ahACJaJh@ahA5CJaJ hA5(jh@ahACJUaJmHnHujh@ahACJUaJ#jh@ah@aCJUaJ#    Social:  FORMTEXT       Does student attend school willingly and consistently?  FORMTEXT       Have you had a conference with parent/guardian about this problem behavior?  FORMCHECKBOX  Yes  FORMCHECKBOX No Date of conference:  FORMTEXT       Results/Changes made:  FORMTEXT       Describe previous interventions and indicate the degree of success of each, including rewards and punishments:  FORMTEXT       What are the student s favorite things to do? (possible reinforcers)  FORMTEXT       Reinforcers that did not work with this student:  FORMTEXT           N P d f h r t X!Z!n!p!r!|!~!! """$"&"("2"4"6"ǵҠǎҠ|Ҡuq_Ҡq#j h@ah@aCJUaJhA hAhA#jl h@ah@aCJUaJ#j h@ah@aCJUaJ(jh@ahACJUaJmHnHu#jp h@ah@aCJUaJh@ahACJaJjh@ahACJUaJj hAh@a5U hA5jhA5U%6"8""""""""""߭(jh@ahACJUaJmHnHu#jX h@ah@aCJUaJh@ahACJaJjh@ahACJUaJhA hA5hAhA5 21h:pbU/ =!"#$% 6Dd z  S 0ABD21328_S"bhzwBZy2.XəDDn<zwBZy2.XəPNG  IHDR Þ`PLTEֱ|||wwwDtRNS@f cmPPJCmp0712HsaIDATXG։ DD`wCGG`3)I4z$K5"yH v-'(" Q^wo;J\]g&WLC,x=^5\5d8XP0}s 8QRmd@$&@{4b`` ` `UnknownGz Times New Roman5Symbol3& z Arial"qh{ä&ä&  P">4d``3QHP)?A*FUNCTIONAL BEHAVIOR ASSESSMENTYour User NameYour User Name Oh+'0 4@ ` l x  FUNCTIONAL BEHAVIOR ASSESSMENTYour User NameCopy of FBA.dotYour User Name1Microsoft Office Word@ԭ@@rg%g@Fg՜.+,0 hp  Crockett County Schools ` FUNCTIONAL BEHAVIOR ASSESSMENT Title  !"#$%&'(*+,-./02345678;Root Entry F@$g=Data 1TableWordDocument4(SummaryInformation()DocumentSummaryInformation81CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q