STAR PROGRAM - DAILY PROGRESS REPORT FORM

Illinois PBIS Network

Student Name: Day: Date:
Checked-in by: Checked-out by: Parent Signature:
Daily Points Possible: 20 Daily Goal: Points Received: # of Universal Recognitions Received:
Notes:

= 2 Points = 1 Points = 0 Points

Have a great day. We know that you can do it.

Goal Evening Morning Morning Arrival and Morning Lunch & Recess
Bus/car/walk Bus/car/walk Star Program Attitude

2 1 0 2 1 0 2 1 0 2 1 0 2 1 0

Check-in Check-in Check-in Teachers Teachers

Teacher Teacher Teacher Initials: Initials:
Afternoon Music, Art, and Gym LDR or Reading Classroom Teacher Evening Departure and Point
or Classroom Teacher Bonus Star Program Attitude Total

2 1 0 2 1 0 2 1 0 2 1 0 2 1 0

Teachers Teachers Teachers Teachers Check-out

Initials: Initials: Initials: Initials: Teacher

DAILY GOAL REACHED? YES OR NO

 STAR Program

Student Contract

I, _________________________________________ agree to follow the rules of the PBIS training and I know the
three behavioral expectations, Be Respectful, Be Responsible, and Be Safe. (See attached Matrix)

I will work with ______________________, my trainer to help me meet my daily behavior goal everyday by being
respectful, responsible and safe at school. I will give my daily progress report form to my parent/guardian for a
signature every day.

My teachers and I will work together everyday using my daily progress report form. Teachers will help me
understand how I am doing with my behavior, give me points when I am respectful, responsible and safe and sign
my daily progress report form.

I understand that my daily point goal is _____ out of a possible 20 points. I understand that when I make my goal for
____ weeks, my STAR teacher and I will talk about how I am doing. Together we will decide what support I may
continue to need from the STAR Program to do my very best every day at school.

I will try hard to meet my point goal every day.

Student Signature: ________________________________ Date: _______

Parents/Guardians understand that data (Week Starting Date, Student Name, Daily Goal, Achieved, # of Universal
recognitions received, # of enrolled students, # of parent signatures received and # of lost daily progress report forms) will
be gathered on a daily basis and shared with the appropriate school staff to support our students social emotional
and academic learning at school. This data will enable effective decision making and help staff assist, motivate,
encourage and support our students best effort. Parents can receive a copy of the data collected upon request. Please
join us and together we can support and celebrate your childs successful participation in this program.

Parent/Guardian Signature: _________________________ Date: _______

Parent/Guardian Signature: _________________________ Date: _______
STAR Representative Signature: _____________________ Date: _______