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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