HTML Preview Student Action Plan Form page number 1.
!Action'Plan'Form'
Problem'
Specific'Activities'
(student'fills'in'th is'se ctio n'with'
activities/strategies'planned'to'
help'reach'expected'outcome)'
Outcome'Measurement'(what'CI,'
student'must'see,'hear,'feel'to'
achieve'the'expected'outcome'and'
verify'accomplishment)'
!
!
!
!
Consequences'for'unsuccessful'completion:'
!
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Learning Objective should be:
1. Specific
2. Measurable
3. Achievable
4. Results centered
5. Time bounded
!At!completion!of!the!time!frame:!
Student!signature! __________________________________!
CI!signature! ! __________________________________!
Date! ! ! __________________________________!