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Functional Behavior Assessment - Liberty University- Educ 624

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Functional Behavior Assessment - Liberty University- Educ 624
FBA FORM

|Functional Behavioral Assessment |
| |
|Fictional Student Name: Michael Grand Caymen DOB: 07/30/2005 Date: 03/03/2013 |
|Data Sources: X( Observation | X( Student Interview | X( Teacher Interview | X( Parent Interview | ( Rating Scales | ( Normative Testing |
|Description of Behavior: |
| |
|Student isolates himself from others at various times of the day to include lunchtime, bathroom break time and recess; student makes inappropriate sounds during|
|instructional time; student refuses to follow adult authority or follow classroom policies; student is consistently out-of-seat without permission/wandering |
|about the room during instructional time. |
|Setting(s) in which behavior occurs: |
| |
|Behavior is exhibited in the classroom, hallways, cafeteria and playground. |
|Frequency:
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