Training Verification For Bips, Health Plans And/or Safety Plans

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SOUTH   B END   C OMMUNITY   S CHOOL   C ORPORATION  
SPECIAL   E DUCATION   S ERVICES  
TRAINING   V ERIFICATION   F OR   B IPS,   H EALTH   P LANS   a nd/or   S AFETY   P LANS  
The   b elow   n amed   s tudent   h as   a   B ehavioral   I ntervention   P lan   ( BIP)   a nd/or   H ealth   P lan   a nd/or  
Safety   P lan   a s   p art   o f   h is/her   I EP   f or   t he   2 016- 17   s chool   y ear.  
Student   N ame:  
  S BCSC   I D#:            
  S TN#:  
School:  
  D ate   o f   B irth:  
I   h ave   b een   t rained   i n   t he   p rocedures   a nd   s trategies   i n   t his   s tudent’s   m ost   r ecent   B ehavioral  
Intervention   P lan   a nd/or   H ealth   P lan,   a nd/or   S afety   P lan   i n   t he   I EP   d ated   _ ___________.     I  
am   a ware   t hat   t hese   m ust   b e   i mplemented   d aily   a s   w ritten.  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
__________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
___________________________________  
___________________________  
____________  
Name    
Role  
 
Date  
I   h ave   t rained   t he   a ppropriate   p araprofessionals   a nd   s taff   r egarding   t he   p rocedures   a nd   s trategies  
outlined   i n   t his   s tudent’s   m ost   r ecent   B ehavioral   I ntervention   P lan   a nd/or   H ealth   P lan,   a nd/or   S afety  
Plan   i n   t he   I EP   d ated   _ _____________.  
_____________________  
____________  
TOR  
Date  
Rev.   9 /2014

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