REPORTS, FORMS, AND INFORMATION
TABLE OF CONTENTS
YEARLY TIME LOG
CLASSROOM GUIDANCE LOG
PERMISSION LETTER
EXPLAINING ROPES COURSE
TRANSITIONING MIDDLE SCHOOL LETTER
TRANSITIONING ACTIVITY LETTER
FRIEND BINGO
COUNSELOR PASS
TEACHER NEED ASSESSMENT FOR INDIVIDUAL COUNSELING REFERRALS
PERMISSION FOR INDIVIDUAL COUNSELING
SMALL GROUP SESSION LOG
MEDIATION AGREEMENT
PEER MEDIATION LOG
C. A.R.E. TIER 1
C.A.R.E. TIER 2
C.A.R.E. 1 REFERRAL
HEALTH INFORMATION (EDSCREEN)
C.A.R.E. TEAM MEETING
C.A.R.E. CONSULTATION REQUEST
C.A.R.E. INTERVENTION PLAN
C.A.R.E. CLASSROOM OBSERVATION REQUEST
C.A.R.E. PARENT CONTRACT
INFORMATION READ TO A CLASS REGUARDING TRAGIC NEWS (DEATH,
ACCIDENT,ETC)
CRISES LETTER TO PARENTS
CLASSROOM ANNOUNCEMENT FOR DEATH, ACCIDENT, ETC.
CRISES STUDENT LOG
COUNSELOR & COMMUNITY SUPPORT LOG
AT-RISK IDENTIFICATION (BLUE CARD)
PARENT CONTACT LOG
TIME DISTRIBUTION SUMMARY
COUNSELOR QUARTERLY REPORT FORM
NEW STUDENT INFORMATION CHECK LIST
DAVE LESSON CHECK LIST
INDIVIDUAL COUNSELING LOG
PERMISSION TO PARTICIPATE IN GROUP COUNSELING SERVICES
PARENT SURVEY
PARENT SIGN-IN LOG
REFERENCE MATERIAL
GUIDANCE BOOK LIST
SURVEYS
STUDENT COUPONS
STEPS TO RESPECT POWER POINT
DRUG AND VIOLANCE EDUCATION (D.A.V.E.) POWER POINT
LANGUAGE PROFICIENCY ASSESSMENT COMMITTEE (LPAC) POWER POINT
1
2
8
9
10
11
12
13
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
37
38
39
40
41
42
43
44
45
47
48
53
62
65
82
87
TIMELINE
DATE CORRELATION
STAFF DEVELOPMENT WEEK
TEACHER WORKWEEK
D
DAY
1
2
3
4
5
DATE
ACTIVITY
NON-DATED ACTIVITIES
PRESENT STAFF DEVELOPMENTS REQUESTED BY PRINCIPAL
•
•
•
•
•
•
CONFLICT RESOLUTION
CRISIS MANAGEMENT
LEP (BILINGUAL, ESL)
PEER MEDIATION
SECOND STEP
SPECIAL PROGRAMS
ACADEMIC CALENDAR
1ST SIX WEEKS
DAY #
1
2
3
4
5
6
7
8
9
10
DATE
ACTIVITY
GIVE AT- RISK LIST TO TEACHERS
2
DAY DATE ACTIVITY
11
12
13
14
15
16
17
18
19
20
All LPACS & TERRA NOVAS
complete
21
22
23
24
25
26
27
28
29
Collect AT- RISK INTERVENTIONS &
& DAVE
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
2nd Six Weeks
GUIDANCE and SMALL GROUPS
BEGIN
AT- RISK & QUARTERLY
REPORTS DUE TO ADMINISTRATION
3
END 1ST NINE WEEKS
DAY DATE SCHEDULED ACTIVITY
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Collect AT- RISK INTERVENTIONS
& DAVE
60
PRS; SIX WEEKS REPORTS;
TIME DISTRIBUTION DUE
3RD SIX WEEKS
61
62
63
64
65
66
67
68
69
70
71
72
72
73
74
75
76
77
78
79
80
81
82
83
4
DAY DATE SCHEDULED ACTIVITY
84
85
86
87
88
89
Collect AT- RISK INTERVENTIONS
& DAVE
90
PRS; SIX WEEKS REPORT; TIME
DISTRIBUTION; QUARTERLY
REPORT; 1st SEMESTER REPORT
due
END 2ND NINE WEEKS
END 1ST SEMESTER
4TH SIX WEEKS
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
5
DAY
111
112
113
114
115
116
117
118
119
120
DATE
ACTIVITY
Collect At -Risk Interventions & DAVE
PRS; SIX WEEKS REPORT; TIME
DISTRIBUTION DUE
5TH Six Weeks
BEGIN END OF YEAR LPAC TESTING
7 MEETINGS
121
123
124
125
126
127
128
129
130
131
132
133
134
135
QUARTERLY REPORT DUE
End 3rd Nine Weeks
DAY
136
137
138
139
140
141
142
143
144
145
146
147
DATE
ACTIVITY
6
Day
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
Date
Activity
COLLECT AT- RISK INTERVENTIONS
& DAVE
PRS;SIX WEEKS REPORT;TIME
DISTRIBUTION DUE
Collect AT- RISK INTERVENTIONS
& DAVE
PRS; SIX WEEKS REPORT; TIME
DISTRIBUTION; QUARTERLY REPORT;
SEMESTER REPORT;
Updated AT- RISK LIST; End of year LEP
DOCUMENTATION due
7
6th Six Weeks
Classroom Guidance Log
DATE
Scheduled Time: ________
M T W Th F
Guidance
School: __________________
Teacher: _________________
PK K 1 2 3 4 5 6
Program:____________
Date
Time in
Classroom
Lesson/activity
8
Notes
Sample of a Parent Letter
Date
Dear Parent,
During the current school year the counselor, nurse and/or a classroom teacher
will be presenting the following presentations:
4th Grade - Bloodborne Pathogens and Other Traveling Germs
4th Grade Girls - Just Around the Corner
4th Grade Boys - Whatsa Hygiene
5th Grade - A is for AIDS
5th Grade Girls and Boys (separately) Always Changing, Always Growing
6th Grade AIDS: Facts for Kids
6th Grade Girls - Growing Up for Girls
6th Grade Boys - Growing Up for Boys
This information is designed to prepare young people for the physical changes
they will experience in the upcoming years. Growth and development changes in the
body can often be confusing for your child. These videos help to provide education and
needed information for students to understand these changes. Parents are welcome to
preview the videos on _______. A group discussion will take place following the video
with the individual groups. Also, personal hygiene products for males and females will
be discussed with the appropriate group of students. Please complete the permission
form at the bottom of this page and return it to your child’s teacher by ______________.
If you have any questions or concerns please contact the school counselor.
Sincerely,
Principal
Please complete and return the permission form below to your child’s classroom teacher.
I (do do not) give my permission for ________________________________ to view the maturation and
health videos appropriate for the students’ grade level and to participate in the discussion time afterward.
Parent/Guardian’s Name (please print): _______________________________
Parent/Guardian’s Signature: _______________________________________
Student’s Name (please print): _____________________________________
Classroom Teacher’s Name: ________________________________________
Date: ___________
9
Letter to Parents: Explaining Ropes Course
Dear Parent/Guardian,
This letter helps explain the Ropes Course at the __________________
and some of the activities that will take place during this trip.
The course is composed of a series of low elements which are used to
help individuals and groups to work better as teams as well as help build
confidence in individuals. ( Please see the attached handout explaining some of
the low elements.)
The Course experience can offer the following benefits:
• Improves Self Confidence
• Enhances communication skills
• Develops decision making skills
• Teaches conflict resolution skills
• Leadership skills
• Promotes trust
• Increases individual responsibility
• Develops group cohesion
• Builds awareness of group process
• Improves physical fitness and last but not least
• IT’S FUN!!!!!
A trained facilitator is always present and our #1 concern is always safety
and challenge by choice (letting each individual student chose whether
they want to participate or not).
If you have any questions or concerns about these activities, please
don’t hesitate to call me at __________________.
Thank you,
__________, Counselor
School District Name
Safe & Drug Free Schools Office
10
Transitioning to Middle School
Dear Teacher,
Dear Teacher,
Next (date), the Assistant Principals from _ School will be here to talk to your
classes.
I have asked (Principal’s name) and (Principal’s name) to speak to our students
about expectations and the high standards waiting for them next year in Middle
School.
Some of the items they will address are behavior, multiple classes each day,
passing time between classes, tardies, lunchtime, dress code, after school
activities sponsored by the school, grades, time allowed to go to the
restroom, etc. If the students have any questions that they would like to ask,
have them write them down on a sheet of paper and bring them to the assembly.
Following the Principals address, we will have a Q and A period.
We will meet in the cafeteria at ___. I will announce to your classes when to
leave your room. The assembly will last approximately 30 to 45 minutes.
I think this will be very beneficial for you as well as the students. To eliminate
stress, we want to ensure our students are well prepared for the transition to
Middle School. If we see that we need to make any changes, we will work to
align our class expectations for the rest of the semester to that of the Middle
School,.
If you have any questions, feel free to contact me.
Counselor
11
Sample of Preview Activity
Transition
Date
Time
4 years old --- 5th grade
“Parental Involvement”
How to prepare for (school name)
Please make name tags for your children.
They could be something to wear on their heads or around their necks.
Each teacher select a short lesson that will be interesting and possibly make
something that can be taken home when finished. (especially in the lower grades
). At the bottom of the page, give me the name of the activity/ lesson and
skill taught.
Use this time to send home handouts, such as a supply list, etc.
For Pre-K through 2nd grade, will have two 6th graders that will come to your
room and escort your students to the assigned class to visit. They will stay with
these children until it is time to walk them back to your (their) classroom.
3rd through 5th grade. Teachers, you may want to select 1 of your students to
stay with you to tell the upcoming students about their favorite project or
subject, or what they liked the best about that grade. (then go on to their next
class). Please name this student at the bottom of this sheet.
We will move on a bell schedule.
We are not planning to provide snacks.
Lesson description:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________________
Name of child who will talk to the upcoming students:
Please return to counselor on ____________.
Look for more information on _____________
12
FRIEND BINGO
You will need:
Directions:
One copy of “Friend BINGO” for each child
Pencils
1. Pass out a “Friend BINGO” sheet to each
child.
2. Read all of the items so children are familiar
with what they are looking for.
3. When you say “GO” each child moves around
the room trying to fill up his or her card by
having a different friend sign his or her name
or initials in each square.
4. The object of the game is to see if everyone
can fill up his or her card. (You might give a
prize to the first and last persons to complete
their cards.
Ready to Use Self-Esteem Activities for Young Children
Jean R. Feldman, PhD Jossey-Bass. A Wiley Imprint.
San Francisco CA. 1997, www.josseybass.com
13
Friend BINGO
has cat
likes pizza
plays baseball likes to read
is a big
brother
likes to rides
a bike
has a baby
brother or
sister
likes bugs and has a sister
spiders
favorite color
is purple
is a chocolate
lover
likes to play
outside
likes horses
has a pet bird
enjoys singing
likes to watch
has a
television
computer
likes to swim
listens to
music
14
has a dog
COUNSELOR PASS
STUDENT NAME:___________________________________
DATE:___________________ TIME:____________________
TEACHER: ____________________________
RETURN TO CLASS:
DATE: __________ TIME: ____________
COUNSELOR: ______________________
COUNSELOR PASS
STUDENT NAME:___________________________________
DATE:___________________ TIME:____________________
TEACHER: ____________________________
RETURN TO CLASS:
DATE: __________ TIME: ____________
COUNSELOR: ______________________
COUNSELOR PASS
STUDENT NAME:___________________________________
DATE:___________________ TIME:____________________
TEACHER: ____________________________
RETURN TO CLASS:
DATE: __________ TIME: ____________
COUNSELOR:_______________________
15
Teacher needs Assessment for Individual Counseling Referrals
Date: ________
Teacher’s name: ___________________
Student’s name: ___________________
Reason for Referral:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
_________________________________________________
Contributing Factors or Important Information needed by Counselor:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
_________________________________________________
Teacher’s Expectation or Desired Outcome from Individual Counseling
Sessions:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
_________________________________________________
Has this issue been discussed with parents/guardian?
Y
N
If Counselor determines that the student will need more than 3 sessions
will parents/guardian be willing to sign a permission slip? Y N
If this is to be an on-going counseling situation what day and time would
work with your class schedule? ___________________
16
Elementary School
Address
Telephone/Fax Number
Permission for Individual Counseling
I, _________________________________________, give my permission
for my child, ________________________________, to participate in
individual counseling with the school counselor.
___________________________
_______________
Parent/Guardian Signature
Date
17
SMALL GROUP SESSION LOG
School; ___________
Teacher: ______________
PK K 1 2 3 4 5
Date: ___________
Scheduled Time: __________
M T W Th F
Guidance Program:__________
6
Group Attendance
Group
Roster
1
Date
Teacher
2
Date
Session Notes
Number Topics
1
Notes
2
3
4
5
6
7
8
18
3
Date
4
Date
5
Date
6
Date
7
Date
8
Date
Mediation Agreement
Date: _________________
Peer Mediators:
_______________________________________________________________
Disputants:
_______________________________________________________________
Brief description of dispute:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Agreement/Resolution:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Signed: _________________________
Disputant
________________________________
Mediator
__________________________
Disputant
__________________________
Mediator
Follow Up:
Date: __________________
Person conducting follow-up:____________
Results:
________________________________________________________________
________________________________________________________________
________________________________________________________________
ADDITIONAL MEDIATION NEEDED (circle one):
19
YES
NO
Peer Mediation Log
Campus: _______________
Counselor: _____________
School Year: ___________
Date Submitted: ________
Six-Weeks: 1 2 3 4 5 6
Disputant #1
Grade
Disputant
#2
Grade
Referred
By
20
Mediation
Date
Mediators
Successful
Y/N
San Angelo Independent School District
C.A.R.E. Process
STEP-BY-STEP
THROUGH THE C.A.R.E. PROCESS
TIER I
Action Required
Person
Responsible
Form
To Use
Monitor progress and document
concerns on individual students
Teacher
Teacher
Choice
Consult with Intervention Specialist if
needed
Teacher
None
Contact parent
Teacher
CARE 6
Parent Contact
Implement interventions
Teacher
Can use:
CARE 1 Referral
**If child responds to interventions, continue to monitor
**If child does NOT respond to interventions, go to next step:
Complete referral to CARE Team
Teacher
Referral is placed on next meeting
agenda
Intervention
Specialist
CARE Team meets and determines next
step
CARE Team
**Team may determine that additional data is needed
regarding health, home situation, etc.
Next meeting is scheduled to review
**Team develops an Intervention Plan and requests
assistance from resource personnel.
Process now proceeds to Tier II
21
CARE 1 Referral
EDSCREEN HI
Teacher brings
completed forms
(above) and relevant
work samples
CARE 3 Request
CARE 2 completed at
meeting
CARE 2 Meeting
CARE 3 Request
CARE 4 Int. Plan
!
C.A.R.E. Process, Step-by-Step, cont….
TIER II
Person
Responsible
Action Required
Form
To Use
Implement interventions, document
results, and gather additional data
Teacher
CARE 4 Int. Plan
Conduct additional evaluations, gather
data recommended at the CARE Team
Meeting
Resource
personnel as
designated
CARE 3 Request
CARE 5 Obsv.
CARE Team meets again, reviews all
data and refines, modifies the
Intervention Plan.
CARE Team
CARE 2 Meeting
CARE 3 Request
CARE 4 Int. Plan
CARE 5 Obsv.
Implement interventions
Teacher and
Resource
personnel
Intervention Plan
CARE Team meets, again reviews
impact of interventions
CARE Team
CARE 2 Meeting
"IF CHILD IS RESPONDING TO INTERVENTIONS, TEAM CAN RECOMMEND:
#Interventions continue, child remains on Tier II, next meeting scheduled
OR
#Interventions can be discontinued, child returns to Tier I
"IF CHILD IS NOT RESPONDING TO INTERVENTIONS, THE TEAM CAN
RECOMMEND:
#A new intervention plan can be developed, child remains on Tier II, and progress
is reviewed again in 4-6 weeks
OR
#A referral to 504 or special education is needed.
22
!
San Angelo Independent School District
C.A.R.E. Process
REFERRAL TO THE C.A.R.E. TEAM
Student: ___________________________Grade:______D.O.B:_____________
Teacher: ____________________________Date:_________________________
Parent contacted on:________________
Date
Discussion:___________________________________________________________________
_____________________________________________________________________________
Area(s) of Concern:
Academic Behavioral Social Health
Speech
Other
Specific Interventions Already Tried
Areas of Strength
Results
Date Received:_______________________
CARE 1 Referral
23
STUDENT NAME:
ID#:
SCHOOL:
GRADE:
DOB:
HEALTH INFORMATION
VISION:
Date of
screening:
most
recent
Type of screening:
Name and position of person conducting screening:
FAR VISION:
Results:
Passed
Failed
with glasses/contacts
with glasses/contacts
without glasses/contacts
without glasses/contacts
CLOSE VISION:
YES NO
Passed
with glasses/contacts
without glasses/contacts
Failed
with glasses/contacts
without glasses/contacts
As a result of the screening, is there any indication of a need for further assessment or adjustment?
If YES, explain:
Has any follow-up treatment been recommended? If YES, explain:
YES NO
HEARING:
Date of the most recent screening:
Type of screening:
Name and position of person conducting screening:
Results:
Passed
with hearing aids
Failed
with hearing aids
YES
without hearing aids
without hearing aids
As a result of the screening, is there any indication of a need for further assessment or adjustment?
NO If YES, explain:
Has any follow-up treatment been recommended? If YES, explain:
YES NO
HEALTH:
Does the student exhibit any signs of health or medical problems? If YES, cite observations:
YES
NO
YES
NO
YES
NO
Is there a need for further assessment or referral of a medical problem? If YES, explain:
Is student receiving any medication at school? If YES, specify:
Does this student require adaptive equipment or facility adaptation? If YES, specify:
YES
NO
Signature of person completing this section
Position
24
EDSCREEN-HI(Rev.01/04)
C.A.R.E. TEAM MEETING
Team
Attendance:
Name
Review of:
$ Referral
Position
$ Previous Meeting/Intervention Plan
Sources of Data Reviewed:
____________________________________________________________________________
Discussion:
Request for Consultation:
Consultation)
NO
YES
(complete Request for C.A.R.E.
Intervention Plan:
NO
YES
(complete Intervention Plan)
Date of Next Review: _______________________________________
25
CARE 2 Meeting
REQUEST FOR CONSULTATION/
CONSULTATION REPORT FORM
To: _____________________________Date:____________Requested_________________________
by:___________________________________
Student: ______________________________________School: _____________________________
Teacher: ______________________________________Grade: _______________
Parents informed:
$
Conference/CARE Meeting
$
Telephone
TYPE OF CONSULTATION REQUESTED:
$ Dyslexia
$ Reading
$ Math
$ Educational
$ Behavioral
$ Bilingual
$ School Service
Worker
$ Speech
$ Campus Counselor
$ Psychological
$ Nurse
$ GT
COMMENTS:
************************************************************************************************************************
CONSULTATION REPORT: The following were done as part of the consultation:
$ Classroom Observation
Records
(complete Form 1a)
$ Teacher Interview
$ Parent Interview
$ Review of
$ Other:
____________________________________________________________________________________
Summary of Findings:
Recommendations:
$ None at this time
$ FBA
$ GT Eval.
$ Psychological
Eval.
$ Speech Eval.
$ Dyslexia Eval.
$ BIP
$ Educational Eval.
$ Classroom Recommendations (attached)
$ Other:
___________________________________________________________________________
RETURN TO: ___________________________________ AT: ______________________
CARE 3 Request
26
C.A.R.E. Process
INTERVENTION PLAN
DATE DEVELOPED:____________________________________
Student:________________________________Teacher:_______________________
Interventions or Strategies to be
implemented:
Person
Responsible:
Criteria for
Success:
Duration
Reading:
Math:
Behavioral:
Other:
Next Review Date: _______________________________
CARE 4 Int. Plan
San Angelo Independent School District
27
C.A.R.E. Process
Classroom Observation Form
(for use during Tier I and Tier II data collection)
Observer: Rate student’s behavior in each of the areas below, using the following rating scale:
1=poor 2=below average
observed
3=average
4=above average
5=superior
6=not
Receptive Language Skills
Comprehends Word meanings
Follows oral instructions
Comprehends classroom discussion
Remembers information just heard
1
2
3
4
5
N
Expressive Language Skills
Displays adequate vocabulary
Uses adequate grammar for general understanding
Expresses self fluently when called on to speak
Relates a sequence of events in order
Organizes and relates ideas and factual information
1
2
3
4
5
N
Social/Emotional/Behavioral
Cooperates/complies with teacher requests
Adapts to changes in routine without getting upset
Accepts responsibility for own actions
Works cooperatively with others
Has an even, happy disposition
Is pleased with good work
Initiates activities independently
Responds appropriately to praise and correction
Does not discourage easily
1
2
3
4
5
N
Motor Coordination
Exhibits adequate gross motor coordination
Exhibits adequate fine motor coordination
1
2
3
4
5
N
Additional comments:
Completed by: _____________________________________________________
CARE 5 Obsv
28
San Angelo Independent School District
C.A.R.E. Process
Documentation of Parent Contact
Date
of Contact
Type of
Contact
Issues Discussed
C = Conference
T = Telephone
H = Home Visit
CARE 6 Parent Contact
29
Suggested to be read in cases where a staff member will be visiting
classrooms
On ______________ we were given some tragic news. _______________died
on___________. ________________was), killed in a car accident, died suddenly, etc.).
We do not have all the information at this time but will inform you as we learn more.
___________’s (death, accident, injury, etc.) will upset some of you more than others
and it will upset you in different ways just as it has the staff when we were informed. In
the next few days, we will be visiting each class to answer any questions you may have
and to talk about the kinds of reactions you may experience.
Should you want to talk with someone about ____________ and your reactions to
his/her death, please (tell your teacher) (let me know) and arrangement will be made.
National Institute for Trauma and Loss in Children
www.tlcinstitute.org
30
“Sample Crisis Letter”
Use on School Letterhead
Date
Dear Parents:
On _______________, one of our students, _________________, (died, killed, etc.).
The cause of death was _____________(or still being determined by the coroner’s
office.) _______________’s death has had a major impact on our students and staff.
Currently our school Trauma Team is meeting with the closest friends and classmates
of _____________. The Trauma Team is well prepared to assist both students and
staff following such tragic incidents.
It would not be unusual for your child to behave and express him or her self differently
during the next few weeks. Such an incident can have a profound effect on students,
even when they were not in the same class or grade as _______________.
Should you not want your child included in our interventions, call. If you wish to phone
and talk with one of our team members, please be patient as they are very busy
responding to students. If it is an emergency, clearly indicate this to the receptionist so
your call can be given priority. Please use the following numbers for more information.
Non-emergency (school phone number) or emergency (other phone number).
Thank you very much for your concern,
Sincerely,
Principal
National Institute for Trauma and Loss in Children
www.tlcinstitute.org
31
Classroom Announcement
1. Teachers, should be notified at the initial meeting prior to the announcement that
if they have concerns about announcing this to their class, they can ask for
assistance.
2. If there is information about services, it would be appropriate to mention them. If
exams or other school activities are being postponed or changed, it is also
appropriate to mention this.
3. If you are worried about what to do or say, call the Trauma Team for help.
Example Classroom Announcement by Teacher: (TLC 2000)
On ____________________ we were given some tragic news. _______________ died
on ________________. ________________ was (murdered, killed in a car accident,
committed suicide, died suddenly, etc.). We do not have all the information at this time
but will inform you as we learn more. _______________’s (death, accident, etc.) will
upset some of you more than others and it will upset you in different ways just as it has
the staff when we were informed.
National Institute for Trauma and Loss in Children, www.tlcinstitute.org
32
Student Log
Counselor _______________________
Students Name
1.
Grade
Time
In
Time
Out
DATE____________________
Parent Name
Phone #
Home
Father Mother -
2.
3.
4.
5.
6.
7.
8.
9.
10.
33
Phone #
Work
Phone #
Cell
Parent Contact
Counselors and Community Support
School: _____________________
Date: ______________________
Name
Address and Phone
Number
School or Agency
34
Room
Assignment
GRADES Pre-k - 6
NAME
LAST
DOB
SAN ANGELO INDEPENDENT SCHOOL DISTRICT
AT-RISK IDENTIFICATION AND PROGRAM PLACEMENT
FIRST
STUDENT ID #
MI
ETHNICITY
GENDER
Grade Level
8) ESL
5) The student is pregnant or is a parent.
10) Dyslexia Program
6) The student has been placed in
alternative education program in
accordance with Section 37.006
during the preceding or current
school year.
11) School Service Worker Referral
7) The student has been expelled in
accordance with Section 37.007
during the preceding or current
school year.
14) Classroom Guidance
8) The student is currently on parole,
probation, deferred pr5osecution, or
other conditional release.
17) PRS
9) The student was previously reported
through PEIMS to have dropped out of
school.
19) Foster Grandparents
10) The student is in custody or care of
the Department of Protective and
Regulatory Services or has referred to
the department by a school official,
officer of the juvenile court of law
enforcement official.
11) The student is homeless as defined
by 42 U.S.C. Section 11302.
12) the student resided in the
preceding school year or resides in
the current school year in a
residential placement facility in
district, including a detention
facility, substance abuse
treatment facility, emergency
shelter, psychiatric hospital,
halfway house, or foster group
home.
21) 504 Services
5) Gifted & Talented
7) Bilingual
9) Special Education
12) Substance Abuse Prevention and
Intervention.
13) Mentoring Program
15) Individual/Group Support
Intervention.
16) Placement Testing
18) HOSTS
20) Peer Mediation/Conflict Resolution
22) Summer School
23)At a Minimum
35
2009 -2010
4) The student did not advance from one
grade level to the next for one or
more school years.
4) Extended Day
2008 -2009
6) Migrant
3) Tutorials
2007 – 2008
3) A student of limited English
proficiency.
2) Cross Grade Lines
2006 – 2007
1) Pre-K
2005 – 2006
1) Did not pass one or more sections of
TAAS/TAKS/SDAII (At level established by
ARD)
2) The student is in Pre-K, K, or grades
1, 2, or 3 and did not perform
satisfactory on a readiness test or
assessment instrument administered
during the current year.
2004 – 2005
AT-RISK PLACEMENT
PROGRAM
2003 – 2004
2009 -2010
2008 -2009
2007 – 2008
2006 – 2007
2005 – 2006
2004 – 2005
2003 – 2004
STATE AT-RISK IDENTIFICATION
CHECKLIST
GRADES 7 – 12
NAME
SAN ANGELO INDEPENDENT SCHOOL DISTRICT
AT-RISK IDENTIFICATION AND PROGRAM PLACEMENT
LAST
DOB
FIRST
STUDENT ID #
MI
ETHNICITY
GENDER
______________
EXIT DATE__________________
Grade Level
3) The student did not pass one or more
sections of the TAAS/TAKS test.. SDAA II (At
level established by ARD) (Effective Spring 2006
testing
7) Placement Testing
8) Credit-By-Exam Testing
4) The student is pregnant or is a parent.
9) Cross Grade Lines
5) The student has been placed in
alternative education program in
accordance with Section 37.006
during the preceding or current
school year.
6) The student has been expelled in
accordance with Section 37.007
during the preceding or current
school year.
10) Tutorials
7) The student is a student of limited
English proficiency.
15) ESL
11) Extended Day
12) Gifted & Talented
13) Saturday School
14) Migrant
16) Jr. High/Sr. High Summer School
17) 4 Yr. High School Plan
8) The student is currently on parole,
probation, deferred prosecution, or
other conditional release.
18) Correspondence Courses
9) The student was previously reported
through PEIMS to have dropped out of
school.
20) Dyslexia Program
10) The student is in custody or care of
the Department of Protective and
Regulatory Services or has referred to
the department by a school official,
officer of the juvenile court of law
enforcement official.
11) The student is homeless as defined
by 42 U.S.C. Section 11302.
12) the student resided in the
preceding school year or resides in
the current school year in a
residential placement facility in
district, including a detention
facility, substance abuse
treatment facility, emergency
shelter, psychiatric hospital,
halfway house, or foster group home
22) Preparation Program for College
Entrance Exams
23) GED Preparation/Testing
19) Special Education
21) Drug Testing
24) PALS
25) At-Risk Coordinator Referral
26) PRS
27) Reading Improvement
28) School Within-A-School Program
29) 504 Services
30) Credit Recovery
36
2009 - 2010
5) Individual/Group Support
Intervention
6) Career and Technology Education
2008 - 2009
3) Substance Abuse Prevention and
Intervention
4) Classroom Guidance
2007 – 2008
2) Mentoring Program
2006 – 2007
1) TAAS/TAKS Remediation
2005 – 2006
1) The student did not advance from
one grade level to the next for one
or more school years.
2) The student did not maintain an average
equivalent to 70 on a scale of 100 in two
or more subjects in the foundation
curriculum currently or during the last
Semester in the preceding or current school.
2004 – 2005
AT-RISK PLACEMENT
PROGRAM
2003 – 2004
2009 - 2010
2008 - 2009
2007 – 2008
2006 – 2007
2005 – 2006
2004 – 2005
2003 – 2004
STATE AT-RISK IDENTIFICATION
CHECKLIST
(Sample)
Parent Contact Log
School Year
School: ____________________
Counselor:_______________________
Date Submitted: ____________
Date
Parent Name
Student Name
Phone
37
In
Note Comments
Person
SAISD Elementary Counselor
Time Distribution Summary 2005-2006
Date_________________________________
Six Weeks Period_________________________
Counselor____________________________
School__________________________________
Hours
Guidance Curriculum (35% - 45%)
_________________
Classroom activities, Group activities, At-Risk Student Activities
This includes self-confidence development; motivation to achieve; decision-making, goal-setting,
planning, and problem-solving shills; interpersonal effectiveness; communication skills; cross-cultural
effectiveness; and responsible behavior.)
Individual Planning (5% - 10%)
_________________
Career counseling, Individual advisement, Individual assessment interpretation, Schedule changes,
Vocational/Occupational exploration
Referrals of students for gifted, bilingual, students in at-risk situations, special education, and
compensatory education, Transition from one school level to the next including 4-year plan, Personal
Graduation Plan, Pre-registration, Research and secure financial aid for post-secondary education/
Training (Set challenging educational, career, and personal-social goals that are based on selfknowledge and information about school, and the world of work; make plans for achieving short,
intermediate, and long-term goals; analyze how their strengths and weaknesses enhance or hinder the
achievement of their goals; assess their current progress toward their goals; and make decisions that
reflect their plans. This includes age-appropriate, objective-based activities; relevant, accurate, and
unbiased information; and coordinated advisement procedures to facilitate appropriate placement
decisions by students and their parents.)
Responsive Services (30% - 40%)
_________________
Consultation, Teacher conferences, Small group counseling, Individual counseling, Crisis counseling,
At-Risk Student Counseling
(Topics in Texas include academic success, adolescent and child suicide, child abuse and neglect,
school drop-outs, severe stress, substance abuse, school-age pregnancy, gang pressures/involvement,
harassment issues. School-based issues include attendance, school attitudes and behaviors, peer
relationships, study skills, being new to the school, emergent issues in intervention or postvention of a
traumatic event, and violence on campus. Personal issues include career indecision, financial aid,
college choice, death of a family member/friend, family divorce, family abuse, harassment issues, and
suicide prevention.)
System Support (15% - 20%)
_________________
Staff/community development, Professional development, Committee/advisory boards, Program
management/operation, At-Risk Student Management (The services include consultation with
teachers; support for the parent education program and community relations efforts; participation
in the campus-based school improvement plans and goals; implementation of the state and local
standardized testing program; cooperation with relevant research projects; and provision of input
from the students’ perspective to policy-makers and instructional/curriculum planners. Activities
include program development and management; counselor staff development; community outreach;
and development of appropriate written policies, procedures and guidelines.)
Other
Absence from duty, etc.
_________________
TOTAL
Substance Abuse/Violence Prevention Activities
38
_________________
_________________________
Quarterly Report
School Year
School:___________________________________
Counselor’s Name:__________________________
Quarter: (Circle One)
1st
2nd
3rd
4th
HOW MANY:
_________________ARD Meetings
_________________504 Meetings
_________________G/T Screenings
_________________LPACS
_________________Parent Contacts
_________________Peer Mediation
_________________Special Education Referrals
_________________Student Contracts (Individual Counseling)
_________________Support Groups
Check any other activities your are involved in:
AT-Risk:
________Identification
____________Meetings
Referrals:
________G/T Referrals
___________Sp. Ed.
Testing:
________Benchmark Prep.
________RPTE Prep.
________SDAA Prep
________TAKS Prep.
Data Collection:
________New Student
________Paperwork
_________504
_________Benchmark Test Administration
_________RPTE Test Administration
_________SDAA Test Administration
_________TAKS Test Administration
________PEIMS
______TPRI
MISC:
________CARE Meetings
________Child Study
______Pride
________Elementary Leadership Conference ______Help in office
________Other
_____________________________________________________________________________________________
_____________________________________________________________________________________________
39
New Student Information
Permanent File Check List
Name:_________________________
Initials/Date
___________________
___Records From Previous School
___________________
___AT RISK
___________________
___504
___________________
___AEP – Grade K 1 2 3 4 5 6
___________________
___
___Guidance Services
___Classroom Guidance
___Individual Counseling
___Small Group Counseling
___Homeless
___LEP
___ESL
___Bilingual
___Exit date Bilingual
___Monitor: Yr. 1 2
___Parent Deny
___Migrant
___Residential Placement (Foster Care, Shelter, etc.) Previous & Current Year
___Retained – Grade K 1 2 3 4 5 6
___SP Ed.
___TPRI at Risk – Grade K 1 2
___Third Grade Screening
___TAKS At Risk
Reading
______________
Math
______________
Writing
______________
Science
______________
Social Studies ______________
___TAKS – Special Needs
Oral
Small Group
Individual
Span
Exempt
Reading
___
___
___
___
___
Math
___
___
___
___
___
Writing
___
___
___
___
___
Science
___
___
___
___
___
Social Studies ___
___
___
___
___
RPTE
Beginning
Intermediate
Advanced
___TERA NOVA – Taken and Scored
___TERA NOVA – Needs to be given
___TERA NOVA – Exempt until_______________
Other Info____________________________________________________________
Missing______________________________________________________________
40
School: ____________________________
Counselor: _________________________
Date Submitted: ______________
TEACHER CHECK LIST
DAVE LESSIONS
TEACHER NAME
& GRADE
DATE
TAUGHT
LESSON 1
DATE
TAUGHT
LESSON 2
DATE
TAUGHT
LESSON 3
41
DATE
TAUGHT
LESSON 4
DATE
TAUGHT
LESSON 5
DATE
TAUGHT
LESSON 6
Individual Counseling Log
Date
Time
Student Name
42
Grade
Topic
Permission to Participate in Group
Counseling Services
Name of Student________________________________Date_______________
Your child has been referred by his/her teacher to participate in a friendship, selfesteem group. This class will last for 5-6 sessions, meet for 30 minutes per session,
and will help ;your child learn about:
•
•
•
How to identify and appropriately express feelings
How to appreciate that each one of us is special and unique
How to make and be a friend
I do give my permission for my child to participate in this group.
Signature of parent or guardian______________________________________
Date: ___________________________
I do not give my permission for my child to participate in this group.
Signature of parent or guardian_______________________________________
Date: ___________________________
If you have any questions, please call the school Counselor.
43
Parent Survey
If you were to participate in a parenting series, which of the following would be most
valuable to you? Please rank them in order, beginning with number one as most
important and number twelve as least important.
___Networking with other parents
___Knowing that you are not alone (finding out that other parents may be
experiencing similar issues and concerns)
___Learning new skills and strategies for coping with child rearing issues
___Educational activities and games
___Learning what’s normal or can be expected of children at various ages and
stages
___Having a facilitator who is trained in parenting issues
___Role play
___Receiving hand outs which you can take home with you
___Using a workbook which covers the materials
___Gaining a deeper understanding of parenting issues and family dynamic
___Learning about community resources
44
School:_____________________________________
Counselor Name:_____________________________
Date:_______________________________________
PARENT SIGN-IN LOG
DATE
PARENT
SIGNATURE
STUDENT’S NAME
45
TOPIC
Teacher Needs Assessment for
Individual Counseling Referrals
Date: ________
Teacher’s name: ___________________
Student’s name: ___________________
Reason for Referral:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Contributing Factors or Important Information needed by Counselor:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Teacher’s Expectation or Desired Outcome from Individual Counseling Sessions:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Has this issue been discussed with parents/guardian?
Y
N
If Counselor determines that the student will need more than 3 sessions will
parents/guardian be willing to sign a permission slip? Y N
If this is to be an on-going counseling situation what day and time would work with your
class schedule? ___________________
46
Reference
Brown, D., & Brooks, L. (1991). Career counseling techniques. Boston: Allyn & Bacon
Brown, D., & Minor, C.W. (Ed.) (1992). Career need in a diverse workplace: a status
report on planning and problem., Alexandria, NCDA
Commission on the skills of the American Workforce. (1990). Americas choice: High
skill or low wages. New York: National Center on education and the Economy.
DOL. (1991a). Dictionary of occupational titles (4th Ed.) Washington, DC:U.S.
Government Printing Office.
Holland, J.L. (1997) Making vocational choices (3rd Ed.) Englewood Cliffs, NJ: PrinticeHall
Hoyt, K.B. (1977). A primer for career education. Washington, DC: Department of
Education.
Hoyt, K.B., & Lester, J.L. )1995).Learning to work: the NCDA Gallup survey.
Alexandria, VA:NCDA
Johnston, W., & Parker,A. (1987), Workforce 2000: Work and workers for the twentyfirst century,
Indianapolis, IN: The Hudson Institute.
Naisbitt, J., & Aburdene, P. (1990). Megatrends 2000. New York: Morrow.
Sears, S. (1982). A definition of career guidance terms. A National Vocational Guidance
association perspective. Vocational Guidance Quarterly, 31, 137-143
Super, D.E. (1976). Career education and the meaning of work. Washington, D.C:
Office of Education.
W. T. Grant commission on Work, Family and Citizenship. (1988). The forgotten half:
Pathways to Americas youth and young families. Washington, DC: W.T. Grant
Foundation.
Supplies and Material Sources:
Childs Work Childs Play www.childswork.com
Guidance, School Counselor Resources www.counselorresources.com
Marco www.marcoproducts.com
Oriental Trading www.orientaltrading.com
Youth Light, Inc. www.youthlight.com
47
Guidance Book List
Title
Amazing Grace
The Very Lonely Firefly
Attila the Angry
Wemberly worried
English Roses
Picky Mrs. Pickle
Penny Lee and her TV
True Story of Three Pigs
Cinder Edna
Salt in His Shoes
A big fat Enormous Lie
Alexander and the day
Sensitive Issues
An Annotated Guide to
Children’s Literature
An Issues Approach
Lucretia the Unbearable
Bartholomew Bossy
Stand Tall, Molly Lou
Uncle Willy and Soup
How Santa Got His Job
Old Turtle
Grouchy Lady Bug
Sneetches
Friends of a Feather
Arnie the Doughnut
Don’t Laugh at Me
Giant King
Dirty Bertie
When Sophie Gets Angry
My Brother is from Outer Space
The Cow that Went Oink
Humpty Dumpty Eggslodes
What’s the Recipe for Friends
When 1st Grade Takes a Test
Cat’s Got Your Tongue
The Lovables in the Kingdom SE
Zinnia and Dot
The Hurt
My Many Colored Days
Oh, the Places I’ll Go
Author
Mary Hoffman
Eric Carle
Marjorie Shamat
Kevin Henkes
Madonna
Christine Schneider
Glenn McCoy
Jon Scieszka
Ellen Jackson
Deloris Jordan
Marjorie Sharmat
Judith Viorst
Rasinski
Rudman
Issue
Goal - setting
Friendship
Anger
Worry
Cliques, friends
Pickiness
TV too much
Marjorie Sharmat
Marjorie Sharmat
Patty Lovell
DyAnne diSalvo Ryan
Stephen Krensky
Douglas Wood
Eric Carle
Dr. Seuss
Bill Cosby
Laurie Keller
Steve Seskin
Kathleen Pelley
David Roberts
Molly Bang
Vivian Ostrow
Bernard Most
Kevin O’Malley
Greg Williamson
M. Cohen
Charles Schaefer
Diane Loomeras
Lisa Ernst
T. Poleski
Dr. Seuss
Dr. Seuss
Selfishness
Bossiness
Confidence
Helping others
Career Choice
Inner peace
Grouchiness
Prejudice
Being oneself
Self-discovery
Bully, tolerance
Expectations
Bad habits
Anger
Siblings
Uniqueness
Anger
Friends
Test anxiety
Shyness
Self-esteem
Competition
Grief
Moods
Dreams, goals
48
Uniqueness
Dreams
Lying, honesty
Bad days
Title
Miss Nelson is Missing
The Terrible fight
The Pinkish, Purplish Bluish egg
Won’t Your Ever Listen
Alexandra keeper of the Dreams
Blabber Mouse
Grumley the Grouchy
Frizzy the Fearful
Author
H. Alard
Sharon St. Germain
Bill Peet
Carol Cummings
Mary Baumgartner
True Kelley
Marjorie Sharmat
Marjorie Sharmat
Issue
Appreciation
Fighting
Prejudice
Listening
Resiliency
Blabbering
Grouchiness
Fear
Hooway for Wodney Wat
Jeremy’s decision
Stellaluna
Tacky in Trouble
Christopher, Will you Please
Clean
Elmer
A House for Hermit Crab
Little Flower
What do you Say Dear
The Fall of Freddie Leaf
The Giving Tree
How are You Feeling
Dinosaurs Divorce (series)
It’s Not My Fault
Tear Soup
Chrysanthemum
Helen Lester
Ardyth Brott
Junell Cannon
Helen Lester
Itah Sadu
Uniqueness
Careers
Masking
Mischief
Responsibility
David McKee
Eric Carle
Gloria Rand
Individuality
Needs
Determination
Manners
Grief
Grateful
Feelings
Divorce
Responsibility
Grief
Teasing
Shell Silvetstein
Sexton Freymann
Laurene Krasny
Nancy Carlson
Pat Schwiebert
Kevin Henkes
49
Bibliography of Children’s Books
Pre-Kindergarten (up to 5 years)
Asch. Frank. Goody House. New York, NY: Simon & Schuster, 1989.
A book of pictures. Great as a stimulus for discussions.
Bernstein, Stan & Janice. The Bernstein Bears’ Moving Day. New Your, NY:
Random House, 1981. A delightful book with familiar characters who are
Moving to an unfamiliar place.
Bourgeois, Paulette. Frankin’s Bad Day. New York, NY: Scholastic, 1997
Franklin’s friend, Otter, has moved away and nothing seems the same without
Her.
Carlston, Stephen. A Serendipity Book: Rhubarb. Los Angeles, CA: Price Stern
Sloan, Inc., 1995.
“To have a friend, you must be a friend.” A delightful puppy makes friends with
farm animals. Outstanding whimsical characters and beautiful illustrations.
Gilmore, Rachna. Lights for Gita. Gardner, Me: Tidbury House, 1995.
A child’s picture book about an immigrant family who comes to the United
States and the Hindu holiday they celebrate.
Kalan, Robert. Moving day. New York, NY: Greenwillow Books, 1996
The saga of a hermit crab’s quest for a perfect house. The pictures inspire
laughter, and the rhyming text appeals to a sense of rhythm.
McGeorge, Constance W. Boomer’s Big day. San Francisco, CA: Chronicle
books,1994. Moving to a new home in the suburbs as seen through the eyes of
Boomer, the family dog. Beautiful pictures.
Zoltov, charlotte S. Janey. New York, NY: Harper & Row, 1973
When Janey moves, her friend misses her but remembers good times they
Shared in the past.
Bibliography information from “Sailing New Seas” by Norma Frank.
50
Beginning Readers (5-8 years)
Aliki. Best Friends Together Again. New, NyL Greenwillow Books. 1995
The pleasure and joy of a reunion. Robert’s best friend is doming to visit.
Bown, Tricia. Hello, Amigos! New Your, NY: Holt, 1986
A well-photographed essay of a bilingual family moving to a new home.
Flood. Bo. I’ll Go To School Tomorrow If…Minneapolis, MN: Fairview Press,
1997. “I’ll go to school if I can ride on the back of a lion!” declares a young boy
upon entering a new school.
Jackson, Isaac. Somebody’s New Pajamas. New Your, NY: dial Press. 1996
A story with a happy ending about a new boy at school.
Johnson, Angela. The Leaving Morning. Burbank, CA: Orchard Books, 1992
An African-American brother and sister capture the excitement and wistfulness
that saying good-bye can mean.
Komaiko, Leah. Annie Bananie. New York, NY: Harper Collins, 1989
Best friends must part when Annie moves away. This story describes the impact
of the move on the friend who stays behind.
Levine, Ellen. I Hate English! New York, NY: Harper Collins. 1989
Mei Mei isn’t happy with her family’s move from Hong Kong to New York. She
Moves to Chinatown where everybody looks and speaks like she does. But at
school, everything is in English, a strange new language Mei Mei refuses to
speak.
O’Donnel, Elizabeth. Maggie Doesn’t Want To Move. New York, NY: four
Winds, 1997. A single parent and her children have to move.
Parton, Susan. Maybe Yes, Maybe No, Maybe Maybe. New Your, NY: Orchard
Books, 1993. When her mother decides to move, eight year old PK uses her
imagination and storytelling to help her older sister and younger sister adjust to
the circumstances.
Rabe, Bernice A.. A Smooth Move. New York,NY Bradbury, 1988.
A young boy keeps a journal of his move from Oregon to Washington, D. C.
Schulman, Janet. The Big Hello. New York, NY: Morrow, 1990
A first airplane ride and a new home make life exciting for a little girl. Then a lost
doll makes adjustment difficult in the new home until a new friend is found.
Bibliography information from: “Sailing New Seas” by Norma Frank
51
Young Readers (7-10 years)
Biale, Rachel. We are Moving. Berkley, CA: Trycicle Press, 1996
A guided scrapbook project between a parent and child illustrates how a parent
can acknowledge and do something about the anxieties of moving.
Clearly, Beverly. Ramona Quimby, Age 8. New York, NY: Morrow. 1981
Ramona moves and experiences an new school, new teachers, and making new
friends.
Danziger, Paula. Amber Brown is Not a Crayon. New York, NY: Scholastic. 1994
Justin and Amber are best friends, When Justin moves to Alabama in the third
grade, Amber feels the loss.
Harshman, Marc. Moving Days. New York, NY: Dutton, 1994
Tommy is upset about leaving his good friends. But when he is in the attic
packing, he finds old photos and old toys and realizes that memories last forever.
Kahaner, Ellen, Fourth-Grade Loser. New York, NY: Troll, 1992
Mike is a rich boy new at school. His parents are too busy to pay attention to
him, and the kids think he is a snob.
Lobol, Arnold. Ming Ling Moves to the Mountain. New York, NY: Tambourine
Books, 1992. A humorous tale regarding a man’s attempt to move a mountain
away from a house.
McLerran, Alice. I Want to go Home. New York, NY: Tambourine Books, 1992.
Marta finds that having a cat helps her adjust to a new house.
Park, Barbara. The Kid in the Red Jacket. New York, NY: Knoph, 1997
The story of a boy moving and being the “new kid on the block.” He felt it was the
most humiliating and scary time of his life.
Sharmat, Majorie. Gila Monsters Meet You at the Airport. New York, NY:
Macmillian, 1980. A cross-country move where imagination creates a situation for
worse than reality.
Bibliography information from “Sailing New Seas” by Norma Frank.
52
Ropes Course
Pre/Post Evaluation
Part I
Name________________________Name of
School____________________Grade__________
Age_____________Male:______________Female:__________________
Circle one: Hispanic
Other________
White
Black
Oriental
Native American
Date of you course experience
How many times have you been through the Ropes Course? (Circle one)
None 1 2 3 4
I will participate in the ….(check one) Low Course_______High
Course_______Both_____
Name of Group (put your teacher/sponsor name)
__________________________________
How would you rate yourself on each of the following traits BEFORE you go through
the Ropes Course?
Use the following scale:
Terrible
0
1
Average
2
3
4
5
6
Write a number from 1-10 in the blanks
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
Excellent
Communication______
Cooperation_______
Teamwork_______
Trust________
Confidence_________
Leadership skills______
Patience ________
Decision-making ______
Listening Skills _______
Refusal Skills_________
53
7
8
9
10
Part II
How would you rate yourself on each of the following traits after going through the
Ropes Course?
Use the following scale:
Terrible
0
1
Average
2
3
4
5
Excellent
6
7
8
9
10
Write a number from 1-10 in the blank
1)
2)
3)
4)
5)
Communication________
Cooperation__________
Teamwork___________
Trust_______________
Confidence___________
6) Leadership Skills________
7) Patience__________
8) Decision-making_______
9) Listening Skills________
10) Refusal Skills__________
Please answer as HONESTLY as possible:
1) One thing I learned about myself is:
2) One thing I learned about my classmates is:
3) What did I do today that I am particularly proud of?
4) How can I use what I learned at School?
5) How can I use what I learned at Home?
6) Besides getting gout of school, what was the best thing about today?
7) What can the facilitators do to make it better?
54
Second Step Student Survey
Please use the scale 1-4, with 4 being the highest score.
1. Do you understand your feelings and the feelings of others?
1
2
3
4
2. Do you think you will use the problem-solving strategies you have learned?
1
2
3
4
3. How confident do you feel in handling your anger?
1
2
3
4
4. Have you had to use these anger strategies?
Yes
No
55
Steps to Respect Student Survey
Please use a scale of 1-4, with 4 being the highest score
1. Do you feel that Steps to Respect helped you deal with Bullies?
1
2
3
4
2. Have you had to use what you learned in Steps to Respect?
Yes
No
3. Do you feel confident in how and to whom you report bullies?
1
2
3
4
4. After the lesson on joining a group, how comfortable do you feel making friends?
1
2
3
4
5. How confident are you in refusing to be bullied?
1
2
3
4
56
West Texas Training Center
Participant Survey
I. Before coming I…(circle yes or no)
1.
2.
3.
4.
Knew about the Training Center.
Yes
No
Knew what I wanted to be.
Yes
No
Knew about job training (other than college).
Yes
No
Knew that I could start training for a job while still in high school.
Yes
No
II. The Visit: (1=strongly disagree, 2=disagree, 3=neither, 4=agree, 5=strongly
agree)
5. The speakers were interesting. 1
2
3
4
5
6. I will use the information to help me make decisions about my future.
1
2
3
4
5
7. I would enjoy taking classes at WTTC.
1
2
3
4
5
8. Taking a class at WTTC would help me in my future job.
1
2
3
4
5
III. Because of the visit: (1=strongly disagree, 2=disagree, 3=neither, 4=agree,
5=strongly agree)
9. I feel more positive about work.
1
2
3
4
5
10. I feel more positive about school or training.
1
2
3
4
5
11. I know that I have options in choosing my job.
1
2
3
4
5
57
D.A.V.E. Student Impact Survey
To be completed by the D.A.V.E. instructor
Not Some Mostly
100%
at
what
Success
all
1
2
3
4
1.
Students were able to be successful in the
lesson observations which accompanied the
DAVE lesson
2.
Students are able to verbalize or
demonstrate accurately what they learned
from the DAVE lessons.
1
2
3
4
3.
Students are observed using or talking about
information they learned in the DAVE
curriculum.
1
2
3
4
58
Rainbow Days Survey
The lesson I learned in group helped me to: (Circle Yes or No)
1. Make new friends
YES
NO
2. Identify ways I am special
YES
NO
3. Learn ways to express my feelings
YES
NO
4. Know how to make and reach goals
YES
NO
5. Know how to make healthy choices
YES
NO
6. Know how to make good decisions
YES
NO
59
Pride Student Impact Survey
School/Number of Students/Grade
Not
At All
1
1. How beneficial do you feel the community
service activities were in showing you positive role
models?
2. How effective were the Red Ribbon Week
activities and Rally?
3. How strong do you believe your refusal skills
are not to do drugs?
4. Did the positive role models help you to see
that drugs aren’t part of a career and schooling?
60
Somewhat Mostly 100%
2
3
4
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61
Principal Coupon
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62
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64
Slide 1
Under the No Child Left Behind we need to reinforce a
positive environment
Steps to Respect/Bullying
A Violence Prevention Curriculum
Slide 2
Agenda
%
%
%
%
Goals
Defining and Recognizing Bullying
Behaviors
Handling Bullying Reports
Closure
65
Slide 3
Refer to page 4 of the All-Staff Training Manual for
further explanation
Children who are bullied tend to:
&
&
&
&
Experience further rejection from peers.
Have lower self-esteem than other children.
Feel more lonely, anxious, and insecure.
Avoid and dislike school.
Slide 4
Goals of the Steps to Respect
Staff Training
To provide staff with the knowledge and skills to:
& Understand the role of friendships skills to
prevent bullying.
& Recognize bullying behavior.
& Support children who are bullied.
& Intervene effectively in bullying situations.
66
Slide 5
Steps to Respect curriculum definition.
What is Bullying?
Bullying is unfair and one-sided. It happens
when someone keeps hurting, frightening,
threatening, or leaving someone out on
purpose.
Slide 6
What is Bullying?
&
&
&
&
The willful, conscious desire to hurt,
threaten or frighten someone.
Targeting someone for repetitive negative
actions.
An imbalance of power.
A pattern of behavior.
67
Slide 7
Refer to Handout 4, here you will find other forms of
bullying that you may see in the classroom.
Spectrum of Violence
&
&
&
&
&
&
&
Verbal
Physical
Social
Sexual
Visual
Normal Conflict
Bullying/Victim
Slide 8
Characteristics of Those Who Bully
&
&
&
&
&
Significant person who models aggression
Enjoy being in control
Value the rewards of their bullying
Show little or no empathy or compassion
Believe that the victim provokes and
deserves it
68
Slide 9
Characteristics of Those Who Bully
&
&
&
Feel comfortable with and justified with
their behaviors
Very successful at hiding their behaviors
Usually not loners, a small network of
behaviors
Slide 10
Consequences of Bullying
&
&
&
&
We see this happening in the classroom, the class clown
or the person who is seeking attention can sometimes be
the bully therefore takes time away during a lesson or
consistently takes control of the class.
Fearful that association with “victims” may bring
bullying their way.
Lose learning time when attention must be given
to bullies.
Given the message that abusive students are in
charge of the school and that staff is either
helpless to control the situation or in collusion
with the bullies.
See that disruptive behavior is the way to get
attention.
69
Slide 11
Myths about Bullying
&
&
&
&
&
We shouldn’t make too much of bullying. It’s a
natural part of growing up. Adults should ignore
it.
Bullying is a male activity, not common among
females.
Male bullies are anxious people who use bullying
to hide their insecurities.
Bullies usually choose victims who are physically
different or who “look funny.”
Young bullies are generally too smart to pick on
adults.
Slide 12
Myths about Bullying (con’t)
&
&
&
&
&
Bullies are chiefly from culturally disadvantaged,
low income families.
Bullies are usually unpopular.
Bullies usually respond well to kindness and
understanding.
The victims of bullying should be taught how to
fight back.
The bullying is likely to stop when the bully
graduates from high school.
70
Slide 13
Bullying Behaviors
&
&
&
&
Physically hurting or
threatening to hurt
someone
Social exclusion
Insults
Name-calling
&
&
Mean gossip and
rumors
Sexual bullying
Slide 14
Physical Hurt / Threat
&
&
&
Pushing
Hitting
Taking a student’s books, money, supplies,
etc away
71
Slide 15
Social Exclusion
Occurs when a student or students prohibit
another from joining in a play group or
sitting at a lunch table. It is very hurtful and
can be a way of gaining control over another
kid’s behavior.
Slide 16
Insults
Can be nonverbal:
& Rolling the eyes
& Shrugging and looking away
& Putting up a hand
72
Slide 17
Name-calling
It is used to belittle or make fun of someone.
& Face to face
& Behind a person’s back.
Slide 18
Mean gossip and rumors
Are used to injure someone’s reputation and social
relationships. They don’t have to be verbal.
& Passing notes
& Writing graffiti accusing of something undesirable
73
Slide 19
Sexual Bullying
Occurs when a student is fondled, groped, or
bothered with words, actions, or media
images that have sexual content. Sexual
bullying includes events that are
categorized legally as sexual harassment.
Slide 20
Is it Bullying or not?
1.
2.
3.
4.
5.
A big kid keeps pushing a little kid down on purpose.
A group of kids always leaves out the new student
during kickball games-even when she asks to play.
Best friends Molly and Amara fight about whose turn it
is during a Checkers game.
Keisha gets mad and calls Penny a name because Penny
did not come to her birthday party.
Some kids take Kenny’s jacket and play keep-away with
it on the school bus. Kenny tells them to stop, but they
don’t listen.
Refer to page 9 of training manual for legal
consequences. Students have to right to an education
free of sexual discrimination and harassment. In the
U.S. schools can be held liable when they are
“deliberately indifferent” to sexual bullying of one
student by another.
For more behaviors to identify refer to page 5 of the
Training Manual.
Bullying Behaviors: 1, 2, 5
The video may be shown after this time. Refer to page
11 of the training manual for video discussion.
74
Slide 21
The Three Rs of Responding
to Bullying
&
&
&
The second segment of the video may be shown here,
refer to page 12 of the training manual.
Recognizing the bullying.
Refuse the bullying.
Report the bullying.
Slide 22
SAISD Policy
75
Slide 23
Role of School Staff
&
&
&
Refer to page 5 of the Training Manual: It is important
for each of us to take the lead in responding to bullying
in our school and demonstrating to our students how
much we care about their well-being.
All staff members need to be prepared to watch for
bullying and to be ready to intervene and handle reports
from children – regardless of whether or not you are the
child’s teacher.
Students in grades 3 – 5 will be taught that everyone
shares the responsibility of creating a safe, caring,
respectful school. We want to be capable of handling
those reports effectively.
In addition, with children in the lower grades, we want to
watch for bullying behavior so we can intervene and
handle situations even though the younger children
haven’t learned the Steps to Respect steps of recognizing,
refusing, and reporting bullying.
Slide 24
Reporting Bullying
It is important to document bullying behaviors. Student
should always be taught to deal with the issue at hand
but if that doesn’t work, then adult reporting needs to
take place.
Students learn that it is okay to report bullying to
an adult anytime.
They also learn to report bullying to an adult
immediately if:
& Someone is unsafe.
& Someone is touching or showing private parts.
& Refusing doesn’t work.
76
Slide 25
Tattling vs. Reporting
Tattling is when a student tries to get someone
into trouble.
Reporting is when a student tries to keep
someone from getting hurt.
Slide 26
Handling Bullying Reports
The Four A Response Process
Affirm
Affirm the child’s feelings
Handout 9,10
Coaching examples Handout 1
The third video segment may be used at this time. Refer
to page 16 of the Training Manual for discussion and
introduction of the video segment. In addition pages 18
– 19 have role play scenarios for staff to model the 4 A
Response Process.
Ask
Ask questions
Assess
Assess the child’s safety
Act
Coach the child or refer the child for coaching. Tell the child what will
happen next
77
Slide 27
Who Are the Victims/Targets?
&
They are either
Passive/Reactive
Slide 28
To the left you see characteristics of those who are
passive and on the right are characteristics of those who
are reactive. Although they are opposite of one another,
you may see children in either end of the spectrum.
Victims/Targets
&
&
&
&
&
&
Sensitive, shy, insecure
Usually lack social skills
Do not invite attack
Anxious, distressed
May have experienced
trauma
Loners, friendless,
isolated
&
&
&
&
Appears to repeatedly
pester and irritate others
Impulsive, quick
tempered reaction to
intentional or
unintentional physical
encounters
Begin as
victims…become bullies
as they try to retaliate
May look like a
bully…tend to maintain
the conflict or even taunt
78
Slide 29
Prevention/Intervention
Strategies
&
&
&
&
&
This is what we want to see happen at school in the
classroom, outside, everywhere….so that everyone is
aware of how we deal with bullying issues.
Shift the balance of power away from bullies by
empowering students and adults to report
Allow bullies to experience the consequences of
their behavior
Interrupt and redirect bullying behaviors
Provide support for the victim
Define bullying and provide and understanding of
bullying behaviors and effects
Slide 30
Prevention/Intervention
&
&
Clearly defined procedure for when and
how to report bullying
School/classroom consequences for
engaging in bullying behavior
79
Slide 31
Interventions for Victims
&
&
&
&
&
&
&
&
Identify victims
Examine your own
beliefs
Act immediately
Be a good listener
Send a clear message
Teach positive self talk
Help students accept their
differences
See your classroom
through the students’
eyes
&
&
&
&
In some cases we see the victims who suffer the most,
they become the ones who end up in depression later on
in life or exhibiting violent behaviors because they were
never taught to deal with bullies.
Provide safe havens
Get students involved in
groups
Give them opportunities
to shine
Have students keep
journals
Slide 32
Interventions for Bullies
&
&
&
&
&
&
&
Watch and Catch them in
the act
Identify Bullies or
potential bullies
Never bully the bully
Have clear consequences
in place
Communicate with
parents
Keep the focus on the
behavior
Teach leadership skills
&
&
&
&
&
Help students find
mentors
Help students handle
their anger
Give students meaningful
responsibilities
Teach positive ways to
feel powerful
Help students understand
why they bully others
80
Slide 33
Scope and Sequence for Level 1
&
&
&
&
&
&
&
&
&
&
This is an example of the scope and sequence for Level,
which is grade level 3/4see handout 5 for skill units. In
addition there are literature series for each grade level.
Encourage teachers to implement.
Friendship Begins with Respect
Making conversation and finding things in Common
Joining in
What is Bullying?
Standing Up for yourself by being assertive
Refusing to be bullied
Reporting bulling
What is a bystander
Bystanders can be part of the solution
A Class Anti-Bullying Pledge
Slide 34
Resource
Steps to Respect, A Bullying Prevention
Program, Training Manual, 2001
Committee for Children.
81
Slide 1
San Angelo I.S.D
D.A.V.E
Drug Abuse and Violence
Education
Slide 2
Purpose of the D.A.V.E.
Curriculum
• This guide is to be used as a tool for
promoting safe and drug free schools. It
infuses researched based prevention
education curricula to provide students
with consistent, firm, no drug use, no
violence messages in all areas of their
education.
82
Slide 3
Red Flags for Prevention
•
•
•
•
Do not trivialize prevention
Do not use inappropriate guest speakers
Do not engage in self disclosure
Do not group students according to behaviors related to
drug use.
• Do not teach how to use drugs or weapons under the
guise of informing about drugs and weapons.
• Do not sensationalize the drug and violence epidemics.
• Do not expect students to report incidents with no
assurance of support.
Slide 4
Education to change attitudes
and behaviors is a significant
aspect of drug and violence
prevention.
• Teenagers perception that “everyone” is
using drugs
• Teenagers emulating what is seen from
the media
83
Slide 5
Effective Schools
• Analyze local data and based on that analysis,
incorporated prevention in the campus improvement plan
in curriculum development.
• Apply researched based prevention principles when
selecting programs.
• Involve family and community throughout the process
• Establish clear no drug use/no violence measures and
objectives.
• Teach that using alcohol, tobacco and other drugs and
violence are not the norm among young people.
Slide 6
Advertising Techniques
(Taken from a Dave Lesson)
•
Physical Appeal Technique A tobacco ad featuring a pretty girl saying that you’ll be
glamorous, too, if you smoke this brand. An alcohol ad with a strong, rugged man is
saying that you’ll be strong, too, if you drink this product.
•
Having Fun Technique An ad showing people have fun is saying that you’ll have
fun if you use this product.
•
Comparison Technique A tobacco ad saying a certain cigarette is the lowest in tar
and nicotine is implying that this brand of cigarette is healthier to smoke than others.
•
Snob Appeal Technique An ad showing someone rich and famous using a
substance is saying that if you use that substance, you’ll be rich and famous, too.
•
Join the Crowd Technique A commercial showing a big group of people drinking the same beer
and having a good time is saying that if you drink a certain a certain beer, you will be part
of the “in group”.
Symbol Technique A Symbol associates with a product such as a rugged cowboy with a brand
of cigarettes or powerful horses with a brand of beer says that smoking or drinking these
brands will make you appear to be the rustic, outdoor, he-man type.
•
84
Slide 7
Educators Must get Involved in
Teaching Children Life Skills!
The single factor to lower the risk of
school
Violence is “connectedness” to an adult
Slide 8
• Teach that conflict can be resolved without violence.
• Help students to recognize behaviors that lead to
drug use and violence.
• Help students recognize the internal pressures, peer
attitudes, and media that influence them to engage
in alcohol, tobacco and other drugs and or violence.
• Help students develop personal, social and refusal
skills to resist these pressures.
• Reinforce positive behaviors
• Provides developmentally appropriate activities and
materials.
85
Slide 9
• Use materials that are easy for teachers to implement
and culturally relevant for students.
• Use interactive instructional strategies that engage the
learner.
• Cover the essential prevention concepts in multiple
sessions; then reinforce those concepts in the context
of student’s daily experiences.
• Provide professional development and implementation
support for drug use prevention and violence
prevention.
• Evaluate regularly and modify programs based on
evaluation finding.
86
Slide 1
Language Proficiency
Assessment Committee
LPAC
Slide 2
LPAC
&
&
&
Written notice 10
days prior to
meeting
Must give parents the
benefits of
bilingual/ESL
Must be identified and
placed within four weeks
(20 business days) of
enrollment
87
Slide 3
Home Language Survey
Testing
Home Language Survey
English/English
(don’t test)
Spanish/English
(test)
Spanish/Spanish
(test)
* Legislature Ch 89 allows to test
Slide 4
LPAC Committee
Bilingual Program
Pre Kindergarten – 6th
&
&
&
&
Teacher
(Bilingual/ESL)
Counselor
Administrator
Parent
A LEP parent
representative may
take the place of a
parent that does not
attend.
88
Slide 5
LPAC Committee
ESL Program
7th – 12th
&
&
Slide 6
Professional
LPAC Parent Representative
Documentation of LEP
Pre kindergarten – 12th
&
&
&
&
&
&
&
&
&
&
&
Home language survey
Level of language proficiency
Parent approval of entry/placement
Recommendations
Date of entry/placement
Grades
Assessment data Terra Nova
Status
Date of exemption
Date of exit
Date of parent notification
89
Slide 7
Criteria to Consider
&
&
&
&
&
Literacy in Spanish/English
Academic program participation
Number of years in school
Testing history
Academic achievement
Slide 8
Parent Denials
&
&
&
&
If a parent denies then the student will be placed in a
regular class but will still be classified as LEP and
may be exited if they pass TAKS.
The Counselor refers a parent denial to the Principal.
The Principal refers a parent denial to Bilingual
Coordinator.
If parent denial is established, contact Bilingual
Department
90
Slide 9
Qualifications
Pre K thru K
Pre LAS
Pre
K thru K
Score Scale 1 - 5
Score 1 – 4
Student qualifies
LEP
Score 5
Student does not qualify
Non LEP
Administer Terra Nova
Administer Terra Nova if
scores is below 40%
LPAC
Slide 10
LPAC
Qualifications
Grades 1 - 6
LAS - O
Scale Score 1 - 5
Score 1 – 3
Student qualifies
LEP
LPAC
Score 4 – 5
Student does not qualify
Non - LEP
LPAC
91
Slide 11
Exit Criteria
&
&
&
OLPT – Score of 4 or 5
Reading TAKS 70%
(Writing if applicable)
Monitor for 2 years
92