ࡱ> g :bjbjVV 4r<r<2RRRRRfff8zlf6|4"$6666666$8:)6Rq%q%q%)6RR>6---q%FRR6-q%6--V4@G5@ٔ%4 5T6064x;]&;G5;RG5q%q%-q%q%q%q%q%)6)6*q%q%q%6q%q%q%q%;q%q%q%q%q%q%q%q%q% : Functional Assessment Checklist for Teachers and Staff (FACTS-Part A) STEP1: Student/ Grade: Date:Interviewer:Respondent(s):  STEP 2: Student Profile: Please identify at least three strengths or contributions the student brings to school.  STEP 3: Problem Behavior(s): Identify problem behaviors  FORMCHECKBOX  Tardy FORMCHECKBOX  Fight/physical Aggression  FORMCHECKBOX  Disruptive FORMCHECKBOX  Theft FORMCHECKBOX  Unresponsive FORMCHECKBOX  Inappropriate Language FORMCHECKBOX  Insubordination FORMCHECKBOX  Vandalism FORMCHECKBOX  Withdrawn FORMCHECKBOX  Verbal Harassment FORMCHECKBOX  Work not done FORMCHECKBOX  Other  FORMCHECKBOX  Verbally Inappropriate FORMCHECKBOX  Self-injuryDescribe Problem Behavior: STEP 4: Identifying Routines: Where, When and With Whom Problem Behaviors are Most Likely. Schedule (Times)ActivityWith Whom does the Problem Occur?Likelihood of Problem BehaviorSpecific Problem Behavior8:00-9:05Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  69:05-10:00Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  610:00-11:00Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  611:00-12:15Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  612:15-1:05Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  61:05-2:00Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  62:00-3:10Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  63:10Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  6Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  6Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  6Low High  FORMCHECKBOX  1  FORMCHECKBOX  2  FORMCHECKBOX  3  FORMCHECKBOX  4  FORMCHECKBOX  5  FORMCHECKBOX  6 Select 1-3 Routines for further assessment: Select routines based on (a) similarity of activities (conditions) with ratings of 4, 5 or 6 and (b) similarity of problem behavior(s). Complete the FACTS-Part B for each routine identified. Functional Assessment Checklist for Teachers & Staff (FACTS-Part B) STEP1: Student/ Grade: Date:Interviewer:Respondent(s):  STEP 2: Routine/Activities/Context: Which routine (only one) from the FACTS-Part A is assessed? Routine/Activities/ContextProblem Behavior(s) STEP 3: Provide more detail about the problem behavior(s): What does the problem behavior(s) look like? How often does the problem behavior(s) occur? How long does the problem behavior(s) last when it does occur? What is the intensity/level of danger of the problem behavior(s)?  STEP 4: What are the events that predict when the problem behavior(s) will occur? (Predictors) Related Issues (setting events)Environmental Features FORMCHECKBOX  Illness  FORMCHECKBOX  Drug use  FORMCHECKBOX  Negative social  FORMCHECKBOX  Conflict at home  FORMCHECKBOX  Academic failure FORMCHECKBOX  Other:  FORMCHECKBOX  Reprimand/correction  FORMCHECKBOX  Physical demands  FORMCHECKBOX  Socially isolated  FORMCHECKBOX  With peers  FORMCHECKBOX  Other______________  FORMCHECKBOX  Structured activity  FORMCHECKBOX  unstructured time  FORMCHECKBOX  Tasks too boring  FORMCHECKBOX  Activity too long  FORMCHECKBOX  Tasks too difficult  STEP 5: What consequences appear most likely to maintain the problem behavior(s)? Things that are ObtainedThings Avoided or Escaped From FORMCHECKBOX  adult attention  FORMCHECKBOX  peer attention  FORMCHECKBOX  preferred activity  FORMCHECKBOX  money/things  FORMCHECKBOX  Other:  FORMCHECKBOX  hard tasks  FORMCHECKBOX  reprimands  FORMCHECKBOX  peer negatives  FORMCHECKBOX  physical effort  FORMCHECKBOX  adult attention  FORMCHECKBOX  Other:  SUMMARY OF BEHAVIOR STEP 6: Identify the summary that will be used to build a plan of behavior support. Setting Events & Predictors (Antecedent)Problem Behavior(s)Maintaining Consequence(s) STEP 7: How confident are you that the Summary of Behavior is accurate? Not very confident Very Confident 1 2 3 4 5 6  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  STEP 8: What current efforts have been used to control the problem behavior? Strategies for preventing problem behaviorStrategies for responding to problem behavior FORMCHECKBOX  Teach expected behavior  FORMCHECKBOX  Schedule change  FORMCHECKBOX  Seating change  FORMCHECKBOX  Curriculum change FORMCHECKBOX  Log behavior  FORMCHECKBOX  Other: FORMCHECKBOX  Reprimand  FORMCHECKBOX  Office referral  FORMCHECKBOX  Loss of points  FORMCHECKBOX  Parent contact  FORMCHECKBOX  Detention  FORMCHECKBOX  In School Suspension  FORMCHECKBOX Other: The Functional Assessment Checklist for Teachers and Staff (FACTS): Instructions The FACTS is a two-page interview used by school personnel who are building behavior support plans. The FACTS is intended to be an efficient strategy for initial functional behavioral assessment. The FACTS is completed by people (teachers, family, clinicians) who know the student best, and used to either build behavior support plans, or guide more complete functional assessment efforts. The FACTS can be completed in a short period of time (5-15 min). Efficiency and effectiveness in completing the forms increases with practice. How to Complete the FACTS-Part A Step #1: Complete Demographic Information: Indicate the name and grade of the student, the date the assessment data were collected, the name of the person completing the form (the interviewer), and the name(s) of the people providing information (respondents). Step #2: Complete Student Profile Begin each assessment with a review of the positive and contributing characteristics the student brings to school. Identify at least three strengths or contributions the student offers. Step #3: Identify Problem Behaviors Identify the specific student behaviors that are barriers to effective education, disrupt the education of others, interfere with social development or compromise safety at school. Provide a brief description of exactly how the student engages in these behaviors. What makes his/her way of doing these behaviors unique? Identify the most problematic behaviors, but also identify any problem behaviors that occur regularly. Step #4: Identify Where, When and With Whom the Problem Behaviors are Most Likely List the times that define the students daily schedule. Include times between classes, lunch, before school and adapt for complex schedule features (e.g. odd/even days) if appropriate. For each time listed indicate the activity typically engaged in during that time (e.g. small group instruction, math, independent art, transition). Use the 1 to 6 scale to indicate (in general) which times/activities are most and least likely to be associated with problem behaviors. A 1 indicates low likelihood of problems, and a 6 indicates high likelihood of problem behaviors. Indicate which problem behavior is most likely in any time/activity that is given a rating of 4, 5 or 6. Step #5: Select Routines for Further Assessment Examine each time/activity listed as 4, 5 or 6 in the Table from Step #4. If activities are similar (e.g. activities that are unstructured; activities that involve high academic demands; activities with teacher reprimands; activities with peer taunting) and have similar problem behaviors treat them as routines for future analysis. Select between 1 and 3 routines for further analysis. Write the name of the routine, and the most common problem behavior(s). Within each routine identify the problem behavior(s) that are most likely or most problematic. For each routine identify in Step #5 complete a FACTS-Part B How to Complete the FACTS-Part B Step #1: Complete Demographic Information: Identify the name and grade of the student, the date that the FACTS-Part B was completed, who completed the form, and who provided information for completing the form. Step #2: Identify the Target Routine List the targeted routine and problem behavior from the bottom of the FACTS-Part A. The FACTS-Part B provides information about ONE routine. Use multiple Part B forms if multiple routines are identified. Step #3: Provide Specifics about the Problem Behavior(s) Provide more detail about the features of the problem behavior(s). Focus specifically on the unique and distinguishing features, and the way the behavior(s) is disruptive or dangerous. Step #4: Identify Events that Predict Occurrence of the Problem Behavior(s) Within each routine what (a) setting events, and (b) immediate preceding events predict when the problem behavior(s) will occur. What would you do to make the problem behaviors happen in this routine? Step #5: Identify the Consequences that May Maintain the Problem Behavior What consequences appear to reward the problem behavior? Consider that the student may get/obtain something they want, or that they may escape/avoid something they find unpleasant. Identify the most powerful maintaining consequence with a 1, and other possible consequences with a 2 or 3. Do not check more than three options. The focus here is on the consequence that has the greatest impact. When problems involve minor events that escalate into very difficult events, separate the consequences that maintain the minor problem behavior from the events that may maintain problem behavior later in the escalation. Step #6: Build a Summary Statement The summary statement indicates the setting events, immediate predictors, problem behaviors, and maintaining consequences. The summary statement is the foundation for building an effective behavior support plan. Build the summary statement from the information in the FACTS-A and FACTS-B (Especially the information in Steps #3, #4, and #5 of the FACTS-B). If you are confident that the summary statement is accurate enough to design a plan move into plan development. If you are less confident, then continue the functional assessment by conducting direct observation. Procedures for completing the functional assessment, and for designing behavioral support are described in the following references. Step #7: Determine Level of Confidence Use the 1-6 scale to define the extent to which you, the interviewer or the team are confident that the summary statement is accurate. Confidence may be affected by factors such as (a) how often the problem behavior occurs, (b) how long you have known the focus person, (c) how consistent the problem behaviors are, (d) if multiple functions are identified, and (e) if multiple behaviors occur together Step #8: Define what has been done to date to prevent/control the problem behavior In most cases, school personnel will have tried some strategies already. List events that have been tried, and organize these by (a) those things that have been to prevent the problem from getting started, (b) those things that were delivered as consequences to control or punish the problem behavior (or reward alternative behavior).     Adapted from Building Positive Behavior Support Systems in Schools: Functional Behavioral Assessment by Crone and Horner FLMefgtu   7 8 9 > ? M N O P V W e f g }wj}w}w]}jthT=CJUjhT=CJU hT=CJjhT=CJU h WCJh5h WCJ h W5CJ h55CJ h WCJhhT=CJOJQJhhT=CJhh5jCJhh"CJOJQJhh"CJhJh W5CJhJh55CJh= h W5CJaJ$FM^_efgtuRkd$$Ifl"\<(   t4)644 lap(yt $IfgdJ{ h $ ha$gd= udbbbY $Ifgd5kd$$Ifl"\V(   t4)644 lap(yt $IfgdJ{8 9 V }}}$If $IfgdT=pkdz$$Ifl(4) t04)644 lap yt      # $ 2 3 4 ? @ A O P Q \ ] k l m ܹ̬̟ܹ̿̅xkj|hT=CJUjhT=CJUjhT=CJUjlhJCJUjhT=CJUjhT=CJU h WCJj\hT=CJU hT=CJjhT=CJU h WCJjhJCJU hJCJjhJCJU*  # ? d^^^^$Ifkd$$Ifl\(t $  04)4 layt5? @ \ d^^^UU $IfgdT=$IfkdV$$Ifl\(t $  04)4 layt5m      ! # , ʚyrkd^d hCJ h5CJ h W5CJ h55CJh5h WCJOJQJh5h W5CJh5h\5CJ h WCJj, hT=CJUj hJCJU hJCJjhJCJU h WCJ hT=CJjfhT=CJUjhT=CJUjhT=CJU hT=CJ#   QKKKK$Ifkd$$IflrJ(t $ 8~ 04)4 layt5  ! bYP $IfgdJ $Ifgd\kd $$Ifl^\(t $  04)4 layt5! " #  wkkkkk $$Ifa$gdJ{ $$Ifa$gdJ{ykdf $$Ifl40~ ( J04)4 laf4yt5   6 QHHH; p$If]pgd $Ifgdkd( $$Iflr8N d !) 0B*4 layt/  6 7 E F G K L Z [ \ a b p q r w x ޺ްސރvoejhJCJU h5CJjRhCJUjhCJUjfhCJUj hNCJU hNCJjhNCJUjz hCJUj hCJUjhCJU hCJhhCJOJQJaJhhCJOJQJ'6 9kd$$Iflr8N d !) 0B*4 layt/ $Ifgd p$If]pgdN  9kd:$$Iflr8N d !) 0B*4 layt/ $Ifgd p$If]pgd   ! " ' ( 6 7 8 = > L M N S T b c d i j x y z  ݹݬݟݒ݃|m`jhCJUhhCJOJQJaJ h5CJhhCJOJQJaJjhCJUjNhCJUjhCJUjbhCJUjhCJUjhCJU hCJjhJCJUjhJCJU hJCJ% FG p$If]pgdJ p$If]pgd $Ifgd )*+01?@AFGHTVᄌyᄌljLhJCJUhhCJOJQJaJ h5CJhhCJOJQJaJj(hCJUjhJCJU hJCJjhJCJUjJhCJUjhCJUj^hCJU hCJjhCJU'GHTUV OFFF99 p$If]pgd $Ifgdkd$$Iflr8N d !) 0B*4 layt/ PQ_`aeftuv{⟘{najhCJUjhJCJU hJCJjhJCJUhhCJOJQJ h5CJhhCJOJQJaJjhCJUjhCJUjhCJUj*hCJU hCJjhCJUjhCJU& PF9 p$If]pgdkd$$Iflr8N d !) 0B*4 layt/ $Ifgd{|$%&*+9:;@AOPﬥ{najhCJUj|hCJUjhJCJU hJCJjhJCJUhhCJOJQJ h5CJhhCJOJQJaJjhCJUjzhCJUjhCJUjhCJU hCJjhCJU&P9kdf$$Iflr8N d !) 0B*4 layt/ $Ifgd p$If]pgd9kd $$Iflr8N d !) 0B*4 layt/ $Ifgd p$If]pgdPQVWefglm{|}*ﹲ{njV"hCJUj!hCJUjx!hJCJU hJCJjhJCJUhhCJOJQJ h5CJhhCJOJQJaJjT hCJUjhCJUjhhCJU hCJjhCJU']^_d9kd.$$$Iflr8N d !) 0B*4 layt/ p$If]pgd $Ifgd*+,12@ABGHVWX]^_f⹲~qj&hCJUj>&hCJUj%hCJUjR%hCJUj$hCJU h5CJhhCJOJQJaJj#hCJUjB#hCJU hCJjhCJUj"hCJU,def9kd'$$Iflr8N d !) 0B*4 layt/ p$If]pgd $Ifgd"VWefgklz{|!sj*hCJUj&*hCJUj)hCJUj:)hCJUj(hCJUjN(hCJUhphCJaJ h5CJhhCJOJQJaJ hCJjhCJUj*'hCJU* !"V p$If]pgd $IfgdOFFF99 p$If]pgd $Ifgdkd+$$Iflr8N d !) 0B*4 layt/!"#'(678=>LMNSTbcdijxyz  sj0hCJUj/hCJUj2/hCJU h5CJj.hCJUj-hCJUj"-hCJUj,hCJUj6,hCJU hCJjhCJUj+hCJU-F9 p$If]pgdkd.$$Iflr8N d !) 0B*4 layt/ $Ifgd %&456;<JKLRSCDFGIypyypf_ hJ5CJhFh W5CJhh5jCJhh[CJOJQJhh[CJhJh W5CJhJhJ5CJhFh W5aJ hJ5CJ h WCJ h W5CJ h5CJj1hCJUj 1hCJUj0hCJU hCJjhCJU$QRSTU944$a$kd1$$Iflr8N d !) 0B*4 layt/ $Ifgd p$If]pgdUCDEFGHI $Ifgd[ hgdJ $L]La$gd= $a$ mdddd $Ifgd[kd2$$Ifl \") @ r t)644 lap(yt/J^mhh__ $$Ifa$$a$kda3$$Ifl \") @  t)644 lap(yt/^_abck=>@ABžtgZtžVh Wh[h[CJOJQJh[h\CJOJQJh[h\6CJaJh[6CJaJh%h[6CJaJ h\5CJh[h\CJOJQJaJ h[CJ h\CJ h W5CJ hJ5CJhFh W5CJh[h WCJOJQJh W5B*CJphh W5B*CJph h WCJ hvCJ!^_`amdX $$Ifa$gdv $$Ifa$kd4$$Ifl      0?")  t0)4 lapytabcmhh_ $IfgdJ$a$kd 5$$Ifl      0?")  t0)4 lapytA.ckdv6$$Ifli"))0)4 layt $IfgdJckd5$$Ifli"))0)4 laytAB+&$a$ckdr7$$Ifli"))0)4 layt $$Ifa$gdJckd6$$Ifli"))0)4 laytLwYkd7$$Ifl      0[")   t0)4 lapyt$If $$Ifa$$a$ ./01LM[\]wxƷƥƷƓƷƁrhVrIjh\h/CJU"j:hJB*CJUphhJB*CJphjhJB*CJUph"j?:hvB*CJUph"j9hvB*CJUph"jS9hvB*CJUphjhvB*CJUphhvB*CJph%j8hv5B*CJUphhv5B*CJphjhv5B*CJUph%HlBhi $$Ifa$gdv $$Ifa$ $$Ifa$gdd$If $$Ifa$gdT= %&4568HIWXYZ[lm{|}~qgaTgj=hJCJU hJCJjhJCJUj<h[hvCJUj<h[hvCJUh[h[CJj;h[hvCJUh[hvCJjh[hvCJUhvB*CJphh/B*CJph h/CJjh\h/CJUj+;h\h/CJUh\h/CJ     -./1˿uobuuoUujQ?hJCJUj>hJCJU hJCJjhJCJUje>hvCJUjhvCJU hvCJ h[CJ hv5CJj=hJ5CJU hJ5CJjhJ5CJU hvCJh[hFCJjy=h[hvCJUjh[hvCJUh[hvCJ!1BCQRSUhijks ./0HIWXYop~ƿ|obj&ChvCJUjBhvCJUj:BhJ5CJU hJ5CJjhJ5CJUhvB*CJphhvhv5B*CJph h W5CJ hJ5CJhFh W5CJ hv5CJ hvCJ h[CJj?hvCJUjhvCJU hvCJ!ijk_ZZQK$If $$Ifa$$a$kd=@$$Ifl      \ [")c d c d  t0)4 laytHomdddXRRRX$If $$Ifa$gdv $$Ifa$kd[A$$Ifl  0[")   t0)4 lapyt ~   -./0@AO̼նyrcyryrjEhv5CJU hv5CJjhv5CJUjtEhvCJUjDhvCJUjDhvCJUh/B*CJph h/CJjDh\h/CJUh\h/CJjh\h/CJU hvCJjhvCJUjChvCJU!@bc|}~ $$Ifa$gdv$If $$Ifa$$ 2$Ifa$gdv OPQRbcdrstu{~ABCDFGżŦޒ~rfYLYE h[5CJh/hJCJOJQJh/h[CJOJQJh[5B*CJphh[5B*CJph h W5CJ hJ5CJ h WCJh\h W5CJh/B*CJph h/CJjFh\h/CJUh\h/CJjh\h/CJU hvCJ hvCJ hv5CJjhv5CJUj`Fhv5CJU~a\ZUI@ $Ifgd[ $$Ifa$gd[gdJ$a$kdLG$$Ifl  \ [")c  d  c  d   t0)4 layt&AB%kdfH$$Ifl  \ [")c d c  d  t(0)4 lap(yt $$Ifa$gddBCDEFGHNIII$a$kdI$$Ifl  \ [")c d c  d t0)4 lapyt$IfGHPo ./0HIWŵp`ThF5B*CJphjhF5B*CJUph%j|Kh\5B*CJUph%jKh\5B*CJUph%jJh\5B*CJUphh\5B*CJphjh\5B*CJUph h WCJ h\CJ h WCJ h W5CJh W5>*CJ h W5CJ hJ5CJhFh W5CJ'U}xxoi$If $$Ifa$$a$ikdFM$$Ifl4      L")) t0)4 laf4ytF $$Ifa$gdF $$Ifa$gd\WXYqr'UVWefgЭК|pl`VPCVjNhJCJU hJCJjhJCJUh W5B*CJphh Wh W5B*CJph hJ5CJhFh W5CJ h W5CJ hvCJ%jLh\5B*CJUph%jZLh\5B*CJUphjh\5B*CJUphh\5B*CJphjhF5B*CJUph%jKhF5B*CJUphUV & L r mddddXXddd $$Ifa$gd/ $$Ifa$kdM$$Ifl  0[")   t0)4 lapyt g      ڽڷڧڝzmdTmN h/CJjPh\h/CJUh\h/CJjh\h/CJUhTw>B*CJph hTw>CJjPhJCJU hJCJjhJCJUjPh\h\CJU h\CJjOh\h\CJUjh\h\CJUh\h\CJj%OhFCJUjhFCJU hFCJ % & ' 5 6 7 9 L M [ \ ] _ q r s ɣ죙}pgWpj/Sh\h/CJUh\h/CJjh\h/CJUh\hFCJjRhJCJU hJCJjhJCJU hFCJjQRh\h\CJUjQh\h\CJU h\CJjeQh\h\CJUjh\h\CJUh\h\CJh\B*CJph" !!j!k!C>>$a$kdT$$Ifl  \ [")c  d  c d   t0)4 layt $Ifgd $$Ifa$gd/ $$Ifa$ !!!!!!!![!i!k!######$$$$$%%%%%ŶŤzvmvcvZvZvZvVvZvZhFh[h WCJh[h W5CJhFh WCJh W h[5 h W5 h WCJ h\5CJh\h\CJh\B*CJph"jTh/B*CJUphjh/B*CJUphh/B*CJph"jShJB*CJUphhJB*CJphjhJB*CJUph h/CJ!k!#######$$$$%%%%\'ckdU$$Ifl(4)04 laytF $IfgdF%['\']'''k(l())))**Z*[***++,,,,,,,-- -!-J-L-M---....%/&///-0.000C1D111222222333h= hFh W5CJ h W5>* h[h Wh[h[CJ h[5hFhFCJh[h[CJhFh WCJ h W>*h[h WCJh[h W5CJ h W5h W<\']'''k(l())))Z*[***++,,,,,- $Ifgd[gdF & FgdF- -!-L-M---....%/&///-0.0$a$akd=V$$Ifl(4)04 laytF.000C1D1112233336666_8`888::: : : : ::gd336666_8`888:::: : : ::::0:@:`:t::::::ؾh\hhCJhh6CJ hv6CJ hCJh.jh.Uh[h WCJh WhFh WCJ::::::gd21F:pF/ =!`"`#$% $$If!vh#v #v#v#v :V l" t4)6,5 555 / / p(yt$$If!vh#v #v #v#v:V l" t4)6,5 5 55/ / p(yt$$If!vh#v4):V l t04)654)p yttDeCheck1tDeCheck4tDeCheck8vDeCheck12$$If!vh#vt#v #v$ #v :V l04)5t5 5$ 5 / 4yt5tDeCheck2tDeCheck5tDeCheck9vDeCheck13$$If!vh#vt#v #v$ #v :V l04)5t5 5$ 5 / 4yt5tDeCheck3tDeCheck6vDeCheck10vDeCheck14$$If!vh#vt#v #v$ #v8#v~ :V l04)5t5 5$ 585~ / /  / 4yt5tDeCheck7vDeCheck11$$If!vh#vt#v #v$ #v :V l^04)5t5 5$ 5 /  / 4yt5$$If!vh#v #vJ:V l404),5 5J/ / / 4f4yt5$$If!vh#v#v#v #v:V l0B*555 5/ /  / / 4yt/vDeCheck15vDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 5/ 4yt/hDevDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/vDeCheck15vDeCheck16vDeCheck17vDeCheck18hDevDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/hDevDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/hDevDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/hDevDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/hDevDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/vDeCheck15vDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/vDeCheck15vDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/vDeCheck15vDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/vDeCheck15vDeCheck16vDeCheck17vDeCheck18vDeCheck19vDeCheck20$$If!vh#v#v#v #v:V l0B*,555 54yt/$$If!vh#v #v@ #v#vr:V l  t)6,5 5@ 55r/ / p(yt$$If!vh#v #v@ #v#v:V l  t)6,5 5@ 55/ / p(yt$$If!vh#v#v:V l  t0)55/  /  / 4pyt$$If!vh#v#v:V l  t0)55/ / /  4pyt|$$If!vh#v):V li0)5)4yt|$$If!vh#v):V li0)5)4yt|$$If!vh#v):V li0)5)4yt|$$If!vh#v):V li0)5)4yt$$If!vh#v:V l  t0)5/ /  / / 4pytvDeCheck21vDeCheck22vDeCheck23vDeCheck24vDeCheck25vDeCheck50vDeCheck26vDeCheck27vDeCheck28vDeCheck29vDeCheck30vDeCheck31vDeCheck32vDeCheck33vDeCheck34vDeCheck35$$If!vh#vc #vd #vc #vd :V l t0)5c 5d 5c 5d / / /  /  / / /  / 4yt$$If!vh#v:V l  t0)5/  / / 4pytvDeCheck36vDeCheck37vDeCheck38vDeCheck39vDeCheck50vDeCheck40vDeCheck41vDeCheck42vDeCheck43vDeCheck44vDeCheck50$$If!vh#vc #vd #vc #vd :V l t0)5c 5d 5c 5d / /  / /  / / / / 4yt9$$If!vh#vc #vd #vc #vd :V l  t(0),5c 5d 5c 5d /  / / 4p(yt$$If!vh#vc #vd #vc #vd :V l t0)5c 5d 5c 5d / /  / 4pytvDeCheck21vDeCheck21vDeCheck21hDevDeCheck21vDeCheck21$$If!vh#v):V l4L t0)5)/ 4f4ytF$$If!vh#v:V l  t0)5/  / / 4pythDevDeCheck45vDeCheck46vDeCheck47hDevDeCheck50vDeCheck48vDeCheck49vDeCheck50hDevDeCheck50vDeCheck51vDeCheck52&$$If!vh#vc #vd #vc #vd :V l t0)5c 5d 5c 5d / / /  / /  / / / / 4yt$$If!vh#v4):V l0,54)4ytFx$$If!vh#v4):V l054)4ytF^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH <`< NormalCJ_HmH sH tH 8@8  Heading 1$@&5>@>  Heading 2$$@&a$5>@>  Heading 3$$@&a$5:@:  Heading 4$@&5B*:@:  Heading 5$@&5>*D@D  Heading 6$$@&a$ 5B*CJDA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List 4B@4 Body Text5>*jj T= Table Grid7:V0H@H = 0 Balloon TextCJOJQJ^JaJNo!N = 0Balloon Text CharCJOJQJ^JaJ424 0Header  H$2oA2 0 Header CharCJ4 R4 0Footer  H$2oa2 0 Footer CharCJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 2   m {P*!1~OGWg %3:"%*-/1368:=?DJLMNQSWY[\^`du ?  ! 6 G PdU^aAi~BU k!\'-.0:: !#$&'()+,.024579;<>@ABCEFGHIKOPRTUVXZ]_abce>NVf#3@P\l6FK[aqw !'7=MSciy*0@P`eu{%*:@PVfl|   + 1 A G W    V f k {  " ' 7 = M S c i y    % 5 ; K /L\w%5HXl| .BR/HXo .@Pcs/HXqVf &6L\r2G$G$G G$G$G$G G$G$G$G$G$G G$G$G$G G$G$G$G G$G$G$G$G$G$G$G$G$G G$G G$G$G$G$G$G G$G$G$G$G$G G$G$G$G$G$G G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G G$G$G$G$G G$G G$G G G$G G$G$G$G$G$G$G$G$G$G$G$G$G$G G$G$G G G$G$G G$G$G$G$G G$G G 8@0(  B S  ?4Check1Check4Check8Check12Check2Check5Check9Check13Check3Check6Check10Check14Check7Check11Check15Check16Check17Check18Check19Check20Check21Check22Check23Check24Check25Check26Check27Check28Check29Check30Check31Check32Check33Check34Check35Check36Check37Check38Check39Check40Check41Check42Check43Check44Check45Check46Check47Check48Check49Check50Check51Check52?W$A]7Lax Mx&IlC IpA'Ms2  !"#$%&'()*+,-./0123Og4QmG\r0]6Y} /S0Y /Q7]2222 2 2 2 22222 eoB(}(*+B--B.M.222 2 2 2 2222233333333^^eett  ar +FFTTPa&d d e e   T T E F __``ck@@l} /ksBBCCDDEEHPHYVg 22/202_2`2222^^eett  ar +FFTTPa&d d e e   T T E F __``ck@@l} /ksBBCCDDEEHPHYVg 2222 2 2 2 222/202_2`22220z &pmd jCu$,hh ^`hH.h ^`hH.h pL^p`LhH.h @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PL^P`LhH.h ^`hH.h ^`hH.h pL^p`LhH.h @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PL^P`LhH.h ^`hH.h ^`hH.h pL^p`LhH.h @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PL^P`LhH.m0z jCu                           $#Y}T=JdJTw>=CV1EYFM WD>]J{V`5jF5|u\v (.= /9["\[KSN4v22@FFFF[")2X@UnknownG*Ax Times New Roman5Symbol3. *Cx ArialMNLucida Handwriting5. .[`)TahomaA$BCambria Math"h888gw*Zw*Z2411ރ 3QHX? W2!xx @Functional Assessment Checklist for Teachers and Staff (FACTS-A) Rob HornerThomas, Amanda   Oh+'0  < H T `lt|DFunctional Assessment Checklist for Teachers and Staff (FACTS-A) Rob HornerNormalThomas, Amanda3Microsoft Office Word@G@@^@6"U@|xw*՜.+,0D hp  % Specialized Training ProgramZ1 AFunctional Assessment Checklist for Teachers and Staff (FACTS-A) Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefhijklmnopqrstuvwxyz{|}~Root Entry FData gV1Table;WordDocument4SummaryInformation(DocumentSummaryInformation8Macros @ٔ@ٔVBA @ٔ@ٔdirThisDocument _VBA_PROJECTG PROJECT J  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIKLMNOPS0* pHdProjectQ(@= l W J< rstdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\Windows\system32\e2.tlb#OLE Automation`ENormalENCrmaQF  *,\C mA!OfficgODficg!G{2DF8D04C-5BFA-101B-BDE5gAAe42ggram Files\@CommonMicrosoft Shared\OFFICE14\MSO.DLL#M 14.0 Ob Library%xMSFAs>AMSFBs$3@dD452EE1-E0D8F0A-8-02608C4D0BB4dFM260L'B p&/;"1D|~ AC00}#0B#G 50 A337F09ED-A30E-4A7D-8DFF-6B7BE1@75B45D6Users\mwallace\AppData\Local\Temp\Word8.0d8.exde=@#.E .`M BThisDocumenPtGTisD@mcuQen 2E` H1y",P""+PxME (S"SS"<(1Normal.ThisDocument8(%HxAttribute VB_Name = "ThisDocument" Bas1Normal.VGlobal!SpaclFalse CreatablPre declaIdTru BExposeTemplateDeriv$Custom izC1a  *\G{000204EF-0000-0000-C000-000000000046}#4.1#9#C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA7\VBE7.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.5#0#C:\Program Files\Microsoft Office\Office14\MSWORD.OLB#Microsoft Word 14.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\Windows\system32\stdole2.tlb#OLE Automation*\CNormal*\CNormalW(*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.5#0#C:\Program Files\Common Files\Microsoft Shared\OFFICE14\MSO.DLL#Microsoft Office 14.0 Object Library*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\Windows\system32\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{337F09ED-A30E-4A7D-8DFF-6B7BE175B45D}#2.0#0#C:\Users\mwallace\AppData\Local\Temp\Word8.0\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M  W ThisDocument05579f8ba4ThisDocumentP  FK|`&WordkVBAWin16~Win32Win64xMacVBA6#VBA7#Project1 stdole`Project- ThisDocument< _EvaluateNormalOfficeuMSFormsC OptionButton1k@Documentj`"$& ID="{8671F9EC-D7EA-4CAD-84D3-56488E06795C}" Document=ThisDocument/&H00000000 Name="Project" HelpContextID="0" VersionCompatible32="393222000" CMG="3B3930219125912591259125" DPB="A0A2ABACACACACAC" GC="05070E7716DD17DD1722" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 &H00000002={000209F2-0000-0000-C000-000000000046};Word8.0;&H00000000 ThisDocumentThisDocument  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qPROJECTwmQ)CompObjRr