Tier 3 Individual Behavior Intervention Plan Page 3
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5Setting Events:
(Variables that affect the student’s behavior)
Summary:
(Hypothesis Statements)
Patterns:
(As identified by data collection)
When this occurs:
the student does: (behavior)
to get or avoid: (consequence)
(circumstance)
Outcome:
(Based on FBA)
Recommended Interventions:
A Positive Behavioral Intervention Plan (PBIP) to be developed
FBA completed: Date: _____________Completed by: _________________________Position:__________________________
Positive Behavioral Intervention Plan (PBIP)
Name of Student: ____________________________ Grade: ______________________Date of Meeting: _____________________
Team Members present:
NAME
POSITION
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Parent category: Life