Behavioral Intervention Plan

Student Name: Michael Fox

Behavior
Number

ID: 12345678

Expected Outcome(s)
Goal(s)

Given a direct rule to follow or

directive, Michael will keep his
hands and feet to himself and
not endanger others at all
times.

DOB: October 03, 2005

Intervention(s) &
Frequency of Intervention

The teacher will provide Michael

with a behavior contract to follow.
The teacher will also take
observations and use the students
planner to document and
communicate with home.

Case Manager: Kaylee Dillon

Person Responsible

Goal/Intervention
Review Notes

Special Education
Teacher in the BD/ED
Classroom
Environment

Michael will also follow social

norms: personal space,
inside/outside voice, talking
out, appropriate and
inappropriate touching, etc.

* Review Codes: GA = Goal Achieved | C = Continue | DC = Discontinue

Signatures:

Date: ___2/1/98____

Expected Review Dates: __________ | __________ | __________

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