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Functional Behavior Assessment and Behavior …

1 Functional Behavior Assessment and Behavior Intervention Plan Simpson School District USA Student Name: Bart Simpson DoB: 9/01/98 Age: 14 Grade: 9th School: Springfield Elementary School Student ID: 97531 FBA Date: 10/19/12 Programs/Services: General education BIP Date: 10/19/12 ---------------------------------------- ---------------------------------------- -------------------------------- Background information: Bart was referred for FBA by the RtI team on 9/5/12. He is not currently receiving any special education services. He is not presently on any medications per nurse report.

•During preferred activities that are more interactive and cooperative in nature (e.g., PE, extra-curricular activities, science lab) • Activities in which writing is not required or is minimal (e.g., checking boxes or responses on tasks that do not go beyond one-page).

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