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Futures Tracking Form
Student's Name *
Your answer
Month *
County *
Your answer
School *
Your answer
Name of Teacher/Staff Member completing form *
Your answer
Email of staff member completing form *
Your answer
What are the student's strengths within the classroom? *
Please check all that apply
Required
Student response to redirection is *
The rate at which they are paying attention in class is *
Student participates in classroom activities *
What are your concerns with the student's current behavior in the classroom? *
Please check all that apply.
Required
Please list the current interventions that you are utilizing in the home school setting. *
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Please indicate what type of support The Futures Program could provide you with in an effort to be proactive with regard to the student's successful transition. *
Please check all that apply.
Required
If a visit is needed please indicate the best day and time.
Your answer
Please list any other information that would be pertinent to ensure the student's successful transition and re-integration.
Your answer
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