Psy 357 Progress Report Template

1. 1
NOTE: Everything in ITALICS is to be replaced with
appropriate student-pupil specific information. Italicized words
should be omitted from final draft, replace them with
appropriate text. Bullets and headings are inserted already
where they are needed. The only thing you need to do is to fill
out tables with your pupil’s information and data and replace
italicized text directions with your information. This window
and page should also be deleted from your final report. Page 1
should begin with your cover page. Not all table rows may be
required and additional rows may be required, depending on
the individual pupil of the student.
“Final Fiesta Student Progress Report” courtesy of (and
created by) Gregory A. Worosz. This template is intended to be
used solely for the purpose of creating your “Final Fiesta”
project and should be used ONLY by the individual recipient of
this template. Only Western Michigan University Psychology
practicum coordinators, classroom teachers, practicum T.A.’s,
graduate assistants, professors and/or other qualified personnel
are exempt from any and all usage restrictions of this template
and may apply it as they deem appropriate.

2. 2
Progress Report
for
(Pupil’s Name)
(Date of Report)
Prepared by:
(Your Name)
Western Michigan University
Psychology 357: Special Populations Practicum
Dr. Richard W. Malott
(Your Semester)

3. 3
Progress Report
For
(Pupil’s Name)
Demographic Information
Name of Child: Name of Evaluator:
Date of Birth: Evaluation Date:
Date of Entry into CAS: Age at Evaluation:
Gender:
School:
ADL:
Expressive Language:
Receptive Language:
Inappropriate Behaviors

4. 4
Date of Operational Definition of Possible Functions of
Working Tips
Revision Inappropriate Behaviors Inappropriate Behaviors
Reinforcers

5. 5
Date of
List of Reinforcers Frequency of Use
Revision
• Edibles: •
• Toys: •
• Social: •
Strengths and Weaknesses
Date of Description and Discussion

6. 6
Revision
Strengths •

7. 7
Weaknesses •

8. 8
Skills That Were Worked On During the Semester
Level 1
General Skills Sub Skills Date Started Date Ended # of Trials
Level 2
General Skills Sub Skills Date Started Date Ended # of Trials
Level 3
General Skills Sub Skills Date Started Date Ended # of Trials
(ADD TABLES FOR ADDITIONAL LEVEL SKILLS i.e. 4,5, etc.)

9. 9
General Working Tips
Date of
Description of Working Tip
Revision
•
•
•
•
•

10. 10
Recommendations
Date of
Description of Recommendation
Revision
•
•
•
•
•