Meeting Date:

Page of

Licking Valley Elementary

IAT Plan
Student:
Grade:
Teacher:
Behavior Description Of The Problem Learners Current
Performance

Typical/Grade-level
Performance

Learners Goal

Based On The Following Data:

Outcome:

Description Of Interventions

Data Results

(Intensity, Frequency, Person Collecting Data)

(Attach Graph)

Dismiss/Monitor
Print Name

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Continue

Alter
Signature

Summary

Next Meeting Date:

Title

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Date