Missouri SW-PBS School Recognition Program School Application 2018-2019
The purpose of the Missouri SW-PBS School Recognition Program is to identify and recognize Missouri schools for successful implementation of Schoolwide Systems of Positive Behavior Support. Criteria are based on effective implementation of the essential components outlined by the OSEP Center on Positive Behavioral Interventions and Support.

Successful applicants will demonstrate exemplary performance in the following areas:
1. Positive and/or improved outcomes for students
2. Use of data to direct instruction, problem solving and intervention efforts
3. Active use of creative and engaging recognition systems
4. Implementation of SW-PBS throughout the school environment
5. Systemic orientation of new students, parents and staff throughout the year
6. Active instruction for social and behavioral skills

Instructions:
Complete and submit the Recognition Application Google Form.
All additional materials must be completed and submitted by mail or electronically to your Regional SW-PBS Consultant no later than April 15, 2019.
Materials regularly submitted to consultants need not be resubmitted.
Notification of the award will be made by May 17, 2019.

RECOGNITION RECIPIENTS MUST AGREE TO SERVE AS DEMONSTRATION SITES FOR SW-PBS.

Demonstration sites may be called on to share their success in the following ways: (1) allow representatives from schools or districts to visit your building and attend a SW-PBS Leadership Team meeting, (2) share materials related to implementation, (3) provide data and other aspects of the implementation process for publication purposes, (4) participate in videos or other electronic tutorials produced by MO SW-PBS, and (5) arrange for SW-PBS information from your district/school to be displayed on your website.

To be considered for the Missouri SW-PBS School Recognition Program, this application and supporting documents must be submitted in accordance with the established timelines and meet all criteria.

General Information
Survey and Data Requirements
School or Program Name: *
Please enter your school or program name as you would like for it to appear on the recognition award and publications
District name: *
If your program is not part of a school district, please type "N/A"
Your name: *
First and last name
Email Address: *
Phone #: *
(xxx-xxx-xxxx)
Administrator's name: *
First and last name
Administrator's email: *
School website:
RPDC region: *
Select the MO SW-PBS recognition level for which your school is applying: *
Did 80% or more certified staff complete the Self-Assessment Survey (SAS) in 2018-2019? *
Find this data on the PBISapps.org website, SAS “Total Score” report.
School-wide percentage in place: *
Non-classroom percentage in place: *
Classroom percentage in place: *
Check all training levels at which your school/team has ever received training and/or support from MO SW-PBS: *
Check all that apply
Required
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