ACTION PLAN ____ Of 2

GOAL:

Participant: Mentor:

How will I accomplish the plan?
(What activities/strategies will I use?) / What are the expected outcomes? / How will I measure the outcomes? / Persons Responsible / Status
(Start Date & Projected
End Date, & Completed Date for Each Outcome)

Evaluation

Participant: Mentor: Topic area:

In your notebook, provide your action plan and all supporting documentation including this self-evaluation. Two complete action plans are required.

1. Describe the steps/actions that you used to accomplish your action plan:

2. Describe the actual outcomes and products you completed for your action plan. How did these differ from your expected (planned) outcomes and why?

3. Describe how well you implemented the components of your action plan and what you will do to ensure continued success with the content of this action plan?

4. Discuss how you will apply the knowledge you gained in this action plan to future work with this target student or in your work with

other children with ASD:

OVERALL EVALUATION

NE ASD Network Action Plan Form Page 4 of 4

6/13

Action Plan Evaluation ____ Of 3

Unsatisfactory
(1) / Basic
(2) / Proficient
(3) / Distinguished
(4)
Appropriateness / Action plan did not address
child/situation-specific needs identified by participant / Action plan considered basic child/situation characteristics / Action plan was designed to match specific child/situation needs / Action plan was thoroughly developed to address specifically identified needs; Purpose of action plans steps are clear and relevant
Depth / Action plan is not complete; does not document implementation and/or show forethought related to future application / Steps of action plan and documentation of implementation included basic elements required / A thorough action plan and evidence of implementation to address the needs identified are present / Thorough planning and documentation of implementation are evident; Consideration of relevance to future application is demonstrated
Assessment / No assessment of strengths and needs in this area / Used basic assessment but lacked specific, individual details / Assessment was well-organized and included details necessary for planning / Thorough and finely-detailed assessment was completed and specifically summarized & utilized
Planning / Unclear plan; lacked logical steps necessary for success. / Plan had basic components but lacked details for success. / Plan was well-organized and included details necessary for successful implementation / Plan was of an exemplary nature; well-developed with finely-tuned details which ensured successful implementation
Implementation / Action plan was not implemented fully. / Action plan was implemented. / Action plan was implemented with documented results. / Action plan was implemented with well-documented evidence in every aspect of the implementation
Evaluation / Participant did not reflect on the action plan with mentor. / Participant and mentor reflected on the implementation without documentation available. / Participant and mentor reflected on the implementation with documents to support their evaluation. / Participant and mentor reflected on the implementation with multiple documents to support their evaluation.
Subtotals:
Total: / /24

NE ASD Network Action Plan Form Page 5 of 5

7/2006