; Sample Child Study Intervention Plan
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Sample Child Study Intervention Plan

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									Page 1 of 2 Child Study Team Intervention Plan: James Doe

Child Study Team Intervention Plan
Student: James Doe Date of Birth: 02/5/87 Parent(s): Patricia Doe SSW: G. Jetson, LCSW Date of Meeting: 1/13/06 Target Behavior or Academic Problem (s)  GPA below or at 2.0 Date: January 23, 2006 School: ABC Middle School Grade: 8

Goal(s)  Increase grades to above 2.0 Plan of Action Student Plans:     Seek tutoring for assignments in which he has difficulty Take home text books in which he has homework assignments Talk to teachers on a one-one basis Pace himself and not become overwhelmed

School-wide Plans: Classroom Plans: Mail home biweekly progress reports home beginning 2/10/06 Occasionally ask James questions to ensure he understands the assignments and help him remain on task.  Give time outs to go to the bathroom to cool off or to the social worker’s room  Encourage him to attend after-school-tutoring program. Encourage James to ask questions and to request help when needed Student Support Service Plans:  Social worker will be available if James needs cooling off period  

Page 2 of 2 Child Study Team Intervention Plan: James Doe Family Plans:   James's mother should actively monitor his homework Periodically call his teachers to check on his progress

Community Plans: None Follow up Plan:   Child Study Team (CST) Coordinator, M. West, will monitor James’s progress. Child study review meeting will be held on the 2nd week of February, date and Time: TBA

___________________________________ Child Study Team Coordinator ___________________________________ Child Study Team Member ___________________________________ Principal

____________________ Date ____________________ Date ____________________ Date

I agree to the implementation of the Child Study Intervention Plan for my child ___________________________________ Student’s signature ___________________________________ Parent’s signature ____________________ Date ____________________ Date


								
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