EDSP 429

Behavior Intervention Plan Template

Student: ________________________

School: _________________________

​​​​​​​​​​​​​​​​​​​​​​Date Developed: ______________

Grade: ______________________

Philosophy of Behavior Management

​​​​​​​​​​​​​​​​​​​​​​​​​________________________________________________________________________

Description of Student

Target Behavior

(Identify Target Behavior, Baseline Data, and Intervention Goal)

Hypothesis Statement

Intervention

(Include strategies, rewards & consequences, and implementation schedule. Explain the crisis plan. Attach a behavior contract)

________________________________________________________________________

Record-keeping System

(Identify what data will be collected, how data is collected/recorded & by whom. Include/attach an example.)

Evaluation Schedule

______________________________________________________________________________________

Communication with Parents

(Explain & attach an example)

Next Steps: Discuss the next steps. What happens if the plan is successful? What happens if it is not successful?

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