School Intent to Implement Positive Behavior Interventions and Supports (PBIS) Application

School Intent to Implement Positive Behavior Interventions and Supports (PBIS) Application

School Intent to Implement Positive Behavior Interventions and Supports (PBIS) Application

By completing the School Intent to Implement PBIS Application, you are engaging in important readiness steps. The following outlines the commitments of the PBIS Statewide Team, the School, and the Supervisory Union (SU).

The PBIS Statewide Leadership Team will:

  1. Prepare Supervisory Union Coordinator and PBIS School Coordinator for PBIS
  2. Provide the sequence of training to PBIS School Leadership Teams:
  • Universal -Introductory Forum, Getting to Readiness, First Steps to Implementation, Universal Team Leadership Training
  • Targeted - Coordinator Orientation, Targeted Team Leadership Training
  • Intensive - To Be Developed
  1. Facilitate regional PBIS SU Coordinator/PBIS School Coordinator meetings bi-monthly.
  2. Coordinate ongoing PBIS professional development through a series of topic-based workshops and the BEST Summer Institute.
  3. Provide training and support on School-Wide Information System (SWIS), an on-line data management system for decision-making and reporting.
  4. AsPBIS State Coaches,provide technical assistance and training toPBIS Supervisory UnionCoordinators and PBIS School Coordinators
  5. Assist districts with collecting, interpreting, and action planning around data.

The School ______will:

(school name)

  1. Confirm PBIS School Leadership Team is formed and representative of school staff. This Team should be up to 6-8 individuals and consist of a broad representation of your school (as indicated onthe attached PBIS Readiness Checklist for Schools).
  2. Plan to register the PBIS School Leadership Team’s participation in ONE of the First Steps to Implementation Workshops: December 8, 2009 or April 1, 2010 and the Universal Team Leadership Training on March 17-19 at Lake Morey or June 21-24 at the BEST Summer Institute in Killington. Visit pbsvermont.com for details and registration form.
  3. Identify a .1 FTE (4 hours/week) PBIS School Coordinator (as indicated on the attached Readiness Checklist).

Responsibilities include:

  • Meet with team at least monthly
  • Attendbimonthly Regional PBIS Coordinator meetings
  • Attend all required training events
  • Help team complete tasks on time
  • Help with team organization
  • Data organization and reporting
  • Work with all school personnel on data, systems and practices
  • Participate in Supervisory Union Team meetings (3-4 times per year)
  1. Complete the attached PBIS School Readiness Checklist at 100% readiness (respond to all items with a yes).

The Supervisory Union will:

  1. Ensure that school PBIS Readiness checklists are complete and validated by State Coach
  2. Secure stable funding for efforts
  3. Identify a .1 to .2 FTE Supervisory Union Coordinator (Name:______) for 1-7 schools.

Responsibilities include:

  • Complete or coordinate school-based evaluations and assessments (SET, EBS) and maintain a read-only password for each school's data for the purpose of oversight and technical assistance
  • Act as a liaison between schools and State PBIS Team
  • Establishquarterly District/Supervisory Unionmeetings once there are multiple schools within a Supervisory Union (3-4 times per year)
  • Attend monthly school PBIS team meetings ((3-4 times per year)
  • Developa dissemination strategy to establish visibility (website, newsletter, conferences, TV)
  • Ensurestudent social behavior is a top priority of the district
  • Participate in required training events and meetings
  • Articulate the integration of other School/Supervisory Union initiatives and assure efforts are well integrated

Principal and Superintendentare to sign the Statement of Intent below and send with readiness checklist and registration form and mail or fax it to Anne Dubie:

University of Vermont, CDCI

208 Colchester Ave.,307 Mann Hall

Burlington, VT 05405

Fax: (802)656-1357

I intend to work with my school/supervisory union to complete the readiness steps needed to implement school-wide PBIS over the course of the school year. I am aware that this involves a commitment to complete the initial steps listed above and 100% completion (yes to all items) of the PBIS Readiness Checklist.

______

Superintendent Name Superintendent Signature

______

School Principal Name School Principal Signature

/ School Information Form

Instructions: This form should be filled out for schools that want to use the PBS Surveys web application ( If your school has, or is in the process of, implementing a positive behavior support program and you want to use PBS Surveys, please complete this form below and send it to as an attachment or fax it to 541.346.2471 If you have questions, you can contact us by email or by phone at 541.346.2347.

Required fields are marked with an asterisk (*).

School Information
*School Name: / *District Name: / County:
*Mailing Address: / *City: / *State/Province: / *Zip/Postal Code:
Physical Address: (if different) / City: / State/Province: / Zip/Postal Code:
*Phone: / Fax: / Web Address:
*Grade Levels: (check all that apply)
PrePreK / PreK / K / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / Post12
*School Administrator: / Phone:
( ) / *Email:
*PBS Coordinator Name: / Phone: / *Email:
State PBS Coordinator: / Phone: / *Email:

Additional School Information:

Private School? / Juvenile Justice / Other Alternative? / Alternative Behav Prog? / Early Childhood Prog?
Yes / No
/ Yes / No
/ Yes / No
/ Yes / No
/ Yes / No
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