Holmes Elementary School

AAF Problem Solving and Progress Monitoring Worksheet

Student Name: Grade/Age: Date:

Teachers Involved:

Strengths (Academic, Social, Behavior, Skills, Interests):
Areas of Concern: 1. 2. 3. 4.
Student Goals: 1. 2. 3. 4.

Action Plan

Date Area of Concern Teachers	Screening OR Monitoring Tool Results	TIER 1: Core What, how, how long/often, whom	TIER 2: Supplemental What, how, how long/often, whom	TIER 3: Intensive What, how, how long/often, whom
Date: Area: Teachers:
Progress and Action Summary: Stop, Change, Add	Delivered Yes	Delivered Yes	Delivered Yes	Delivered Yes
Date: Area: Teachers:
Progress and Action Summary: Stop, Change, Add	Delivered Yes	Delivered Yes	Delivered Yes	Delivered Yes
Date: Area: Teachers:
Progress and Action Summary: Stop, Change, Add	Delivered Yes	Delivered Yes	Delivered Yes	Delivered Yes
Date: Area: Teachers:
Progress and Action Summary: Stop, Change, Add	Delivered Yes	Delivered Yes	Delivered Yes	Delivered Yes

End of Year Summary:

Holmes Elementary School

Date:

Small Group AAF Problem Solving and Progress Monitoring Worksheet

Student Names: Grade:

Teachers Involved:

Strengths (Academic, Social, Behavior, Skills, Interests):
Areas of Concern: 1. 2. 3. 4.
Group Goals: 1. 2. 3. 4.

Action Plan

Date Area of Concern Teachers	Screening OR Monitoring Tool Results	TIER 1: Core What, how, how long/often, whom	TIER 2: Supplemental What, how, how long/often, whom	TIER 3: Intensive What, how, how long/often, whom
Date: Area: Teachers:
Progress and Action Summary: Stop, Change, Add	Delivered Yes	Delivered Yes	Delivered Yes	Delivered Yes
Date: Area: Teachers:
Progress and Action Summary: Stop, Change, Add	Delivered Yes	Delivered Yes	Delivered Yes	Delivered Yes
Date: Area: Teachers:
Progress and Action Summary: Stop, Change, Add	Delivered Yes	Delivered Yes	Delivered Yes	Delivered Yes

End of Year Summary:

AAF Conversation Protocol

Each team will have a facilitator, timekeeper and recorder. All members will fully engage and participate.

Review Data: Each team will review data (screenings, work samples, video clips, images, report cards, interview form) prior to discussion.

Student Introduction: Classroom teacher reviews student strengths, areas of concern, background information and explanation to documentation.

Curriculum Introduction: Classroom teacher reviews curriculum expectations (content, structures, and activities) that are strengths/weaknesses.

Problem Solving: Team discusses implementation strategies for Tier 1, 2 (and if needed Tier 3).

Action Plan Development: Team reaches consensus on implementation strategies and a plan is written. The team will determine who, what, when, where and how of each implementation strategy. The classroom teacher will notify the families and the plan will be sent home.