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Student Name: _____ ID#: _____ DOB: _____ School: _____ Grade: _____ Date: _____ 1 Behavior Intervention Plan (BIP) Part 1 Problem Behavior Summary and Goal Statements Step 1: Problem Behavior Summary Statement: From the information provided from the Student Profile and considering all relevant data collected, identify ONE BEHAVIOR to be targeted for intervention. Write a brief summary statement that includes what set off the behavior, the behavior itself and what the student gains from the problem behavior. Setting Event Antecedent (A) Problem Behavior (B) Maintaining Consequence (C) The Function of the Behavior has been determined to be: Check one Step 2: Replacement Behavior: What behavior will the student perform

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