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Notes from Home

Date: _____________

Yesterday afternoon was:

This morning was:

Other important information:

Notes from School

In which environment was instruction provided:

Math

Reading

Spelling

Social

Studies

Science

• Teacher A

• Teacher B

Transitions Today: (+ Good, - Difficult)

(Top row specify transition: Hallway, preferred activity, subject area)

+ -

+ -

+ -

+ -

+ -

+ -

Reinforcers Used:

1. ___________

2. __________

3. __________

4. __________

Strategies Used:

• Weighted Vest
• Transition Warnings
• Deep Pressure
• Walk Break
• Token Board
• Break Card
• ____________

How many times used: _________

Lunch:

• Most
• Half
• Very Little

# of prompts _________

• Teacher A

• Teacher A

• Teacher A

• Teacher A

• Teacher B

• Teacher B

• Teacher B

• Teacher B

Participation with Peers:

• Independent
• Following Peer Lead
• Following Staff Lead
• No Participation

Why? _____________

Prompts :

• Physical
• Gesture
• Verbal
• Visual

Good, hard, and oops about my day: