Family Engagement Survey for
Positive Behavioral Interventions and Supports (PBIS) and Response to
Intervention (RtI)
Our school is involved in something called Positive Behavior Interventions and Supports (PBIS). PBIS is a
method of Response to Intervention (RtI) that specifically addresses student behavior. We are conducting this
survey to see what families know and need to know about PBIS and RtI. Please answer the following
questions. The answers you provide will tell us what we need to do to help families understand PBIS and RtI.
Thank you very much for your help. If you have questions about this, please call ____________________ or
stop in the office and talk to _________________________.
Name (optional) ____________________ Grade of your child(ren)/student________________
Yes
No
1. Have you heard of PBIS from someone within the school?
2. Have you heard of RtI from someone within the school?
3. If you can, please list the school’s behavior expectations
4. Have you used these behavioral expectations at home?
5. Has your child/student received any behavioral acknowledgements or reinforcements for
following and demonstrating the school’s expectations since school started?
6. If you can, please list the school’s academic screening assessments.
7. Are you aware of the process for informing parents when their child does not meet academic
benchmarks?
6. Have you noticed a change in behavior and/or attitude in your school? If yes, what have you
noticed:
_____________________________________________________________________________
_____________________________________________________________________________
7. Are you aware of a team in the school that addresses school wide behavior supports?
8. Are you aware of any family members on that team?
9. Have you received any positive comments about your child/student’s behavior from a teacher
or staff member?
10. Have you received any negative comments from a teacher or staff member about your
child/student’s behavior?
11. Are you aware of a team in the school that addresses children/students’ academic concerns?
12. Do you know if your child/student has participated in Universal Screening for academic
skills?
13. Have you been informed of what happens when your child’s/student’s teacher has concerns
about his/her academic skills?
If you have any comments about any of the above questions, use the space below. Your help is greatly
appreciated. Thank you once again for helping to make our school a better place for everyone, especially our
children.
2/2006 Iowa
Updated:10/2013 WI PBIS Network MGA/JG
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2/2006 Iowa
Updated:10/2013 WI PBIS Network MGA/JG