Microsoft Word - Student Intervention Template

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Hollywood High School- School for
Advanced Studies Student Profile and
Action Plan
Student Name:
D.O.B:
Graduation Year:
Current Grade:
TEAM MEMBERS:
IDENTIFY STUDENT STRENGTHS:
(Based on anecdotal evidence, observation, grades, additional data)
IDENTIFY AREAS OF NEED:
(Based on anecdotal evidence, observation, grades, additional data)
STUDENT INFORMATION: Determine what information has already been gathered
from the following resources:
Counselor:
GATHERING INFORMATION: Determine what information still needs to be gathered
from the following resources:
Counselor:
Parent:
Parent:
Student:
Student:
Support Staff (Special Education
Teacher, Title 1 & EL, Dean, PSA,
LACER):
OBJECTIVE FOR INTERVENTION:
Support Staff (Special Education
Teacher, Title 1 & EL, Dean, PSA,
LACER):
INTERVENTION PLAN: Every member of the team should have a specific responsibility and set a date by which that task will be completed
Team Member:
Follow Up Meeting Notes:
Intervention Strategy/Task:
Completion Date:
Media Entertainment and Technology – SLC Needs and Action Plan
Please have one member of your group make note of your group’s thoughts on the questions below regarding instructional and grading
practices and SLC support. Submit your ideas with your completed Student Intervention Plans and your evaluations at the end of today’s
meeting. Thanks!
In what areas in your classes do students seem to struggle the most?
Why do you think this might be?
What interventions have you tried in your classroom to help students
achieve in the areas of struggle you have identified?
What SLC or school-‐wide support do you think might help students
who are struggling in your classes?
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