TLC Data Collection
Data Analysis: SEL sessions
Date: *
MM
/
DD
/
YYYY
SST Member: *
Enter name of person providing session.
Your answer
Student Demographics
Student Name:
Your answer
Student ID #:
Your answer
Student Homeroom:
Your answer
Other SST:
Check off any other SST member working with student.
Social Emotional Behavior Referral *
Check below all SEL behaviors that apply to student.
Required
SEL Competencies
Check off SEL goals for your session with student or group of students.
SEL Competency 1: Awareness of Self and Others
Students aquire tools to form positive self-worth through recognition of personal qualities
SEL Competency 2: Positive Attitudes and Values
Students acquire skills to build personal and social responsibility as well as respect for others.
SEL Competency 3: Responsible Decision Making
Students learn and apply skills to identify problems, set realistic goals and implement positive solutions to problems.
SEL 4: Social Interaction Skills
Students learn verbal and non-verbal skills for active listening, expressive communication, cooperation, negotiation, and help seeking.
SEL Session Summary
Include a brief summary of today's session:

(Date) Summary...

Anecdotal Notes: *
Your answer
SEL Action Plan
Include a brief action plan with specific steps to be completed by (target date).

(Date of Session): Action plan...

Action Plan. *
I will . . . Student will . . . ***Include the date in this NOTES section.
Your answer
SEL Session Survey
Assess SEL learning outcomes and lesson.
Rate each student using likert scales below.
Participation during SEL lesson *
No Participation
Very Active Participation
Disposition after SEL lesson *
Not positive
Very Positive
Appropriate Verbal Expression of feelings/ideas *
No Verbal Expression
Very Appropriate Expression
Met the SEL competency goal (s) identified above for student. *
Did not meet SEL goal
Met SEL goal
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