k School District Your School Name Counselor Name: First Last School Year: What grade levels will this lesson serve? K 1 2 3 4 5 6 7 8 9 10 11 12 13 Other What is the lesson topic? Please Select the ASCA Mindset Standards that best align with your plan. M 1. Belief in development of whole self, including a healthy balance of mental, social/emotional and physical well-being M 2. Self-confidence in ability to succeed M 3. Sense of belonging in the school environment M 4. Understanding that postsecondary education and life-long learning are necessary for long-term career success M 5. Belief in using abilities to their fullest to achieve high-quality results and outcomes M 6. Positive attitude toward work and learning Which of the Behavior Standards best align with your plan? (Mark all that apply.) B-LS 1. Demonstrate critical-thinking skills to make informed decisions B-LS 2. Demonstrate creativity B-LS 3. Use time-management, organizational and study skills B-LS 4. Apply self-motivation and self-direction to learning B-LS 5. Apply media and technology skills B-LS 6. Set high standards of quality B-LS 7. Identify long- and short-term academic, career and social/emotional goals B-LS 8. Actively engage in challenging coursework B-LS 9. Gather evidence and consider multiple perspectives to make informed decisions B-LS 10. Participate in enrichment and extracurricular activities B-SMS 1. Demonstrate ability to assume responsibility B-SMS 2. Demonstrate self-discipline and self-control B-SMS 3. Demonstrate ability to work independently B-SMS 4. Demonstrate ability to delay immediate gratification for long-term rewards B-SMS 5. Demonstrate perseverance to achieve long- and short-term goals B-SMS 6. Demonstrate ability to overcome barriers to learning B-SMS 7. Demonstrate effective coping skills when faced with a problem B-SMS 8. Demonstrate the ability to balance school, home and community activities B-SMS 9. Demonstrate personal safety skills B-SMS 10. Demonstrate ability to manage transitions and ability to adapt to changing situations and responsibilities B-SS 1. Use effective oral and written communication skills and listening skills B-SS 2. Create positive and supportive relationships with other students B-SS 3. Create relationships with adults that support success B-SS 4. Demonstrate empathy B-SS 5. Demonstrate ethical decision-making and social responsibility B-SS 6. Use effective collaboration and cooperation skills B-SS 7. Use leadership and teamwork skills to work effectively in diverse teams B-SS 8. Demonstrate advocacy skills and ability to assert self, when necessary B-SS 9. Demonstrate social maturity and behaviors appropriate to the situation and environment What curriculum and materials will you use?Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Process Data: What is the projected number of students affected by this activity? What categories of survey items will you use to document perception data? College Plans Goal Setting Bond with school Student Testing Time Management Responsibility Bullying Academic Self Esteem Student Study Skills Student School Climate Survey Student Learning Confidence Mentor Other Explain "Other." What outcome data will you use to measure success? Attendance Bus Suspensions Discipline referrals Tardies Out of school suspensions In school suspensions Dropouts Enrollment in rigorous courses Participation in extra curricular activities. Detentions Standardized Math Score Standardized Reading Scores ACT Scores SAT Scores Graduation Rate FAFSA Completion Other Explain "Other." Contact Person Do you want to write a second plan? Yes No What grade levels will this lesson serve? K 1 2 3 4 5 6 7 8 9 10 11 12 13 Other What is the lesson topic? Please Select the ASCA Mindset Standards that best align with your plan. M 1. Belief in development of whole self, including a healthy balance of mental, social/emotional and physical well-being M 2. Self-confidence in ability to succeed M 3. Sense of belonging in the school environment M 4. Understanding that postsecondary education and life-long learning are necessary for long-term career success M 5. Belief in using abilities to their fullest to achieve high-quality results and outcomes M 6. Positive attitude toward work and learning Which of the Behavior Standards best align with your plan? (Mark all that apply.) B-LS 1. Demonstrate critical-thinking skills to make informed decisions B-LS 2. Demonstrate creativity B-LS 3. Use time-management, organizational and study skills B-LS 4. Apply self-motivation and self-direction to learning B-LS 5. Apply media and technology skills B-LS 6. Set high standards of quality B-LS 7. Identify long- and short-term academic, career and social/emotional goals B-LS 8. Actively engage in challenging coursework B-LS 9. Gather evidence and consider multiple perspectives to make informed decisions B-LS 10. Participate in enrichment and extracurricular activities B-SMS 1. Demonstrate ability to assume responsibility B-SMS 2. Demonstrate self-discipline and self-control B-SMS 3. Demonstrate ability to work independently B-SMS 4. Demonstrate ability to delay immediate gratification for long-term rewards B-SMS 5. Demonstrate perseverance to achieve long- and short-term goals B-SMS 6. Demonstrate ability to overcome barriers to learning B-SMS 7. Demonstrate effective coping skills when faced with a problem B-SMS 8. Demonstrate the ability to balance school, home and community activities B-SMS 9. Demonstrate personal safety skills B-SMS 10. Demonstrate ability to manage transitions and ability to adapt to changing situations and responsibilities B-SS 1. Use effective oral and written communication skills and listening skills B-SS 2. Create positive and supportive relationships with other students B-SS 3. Create relationships with adults that support success B-SS 4. Demonstrate empathy B-SS 5. Demonstrate ethical decision-making and social responsibility B-SS 6. Use effective collaboration and cooperation skills B-SS 7. Use leadership and teamwork skills to work effectively in diverse teams B-SS 8. Demonstrate advocacy skills and ability to assert self, when necessary B-SS 9. Demonstrate social maturity and behaviors appropriate to the situation and environment What curriculum and materials will you use?Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Process Data: What is the projected number of students affected by this activity? What categories of survey items will you use to document perception data? College Plans Goal Setting Bond with school Student Testing Time Management Responsibility Bullying Academic Self Esteem Student Study Skills Student School Climate Survey Student Learning Confidence Mentor Other Explain "Other." What outcome data will you use to measure success? Attendance Bus Suspensions Discipline referrals Tardies Out of school suspensions In school suspensions Dropouts Enrollment in rigorous courses Participation in extra curricular activities. Detentions Standardized Math Score Standardized Reading Scores ACT Scores SAT Scores Graduation Rate FAFSA Completion Other Explain "Other." Contact Person Do you want to write a third plan? Yes No What grade levels will this lesson serve? K 1 2 3 4 5 6 7 8 9 10 11 12 13 Other What is the lesson topic? Please Select the ASCA Mindset Standards that best align with your plan. M 1. Belief in development of whole self, including a healthy balance of mental, social/emotional and physical well-being M 2. Self-confidence in ability to succeed M 3. Sense of belonging in the school environment M 4. Understanding that postsecondary education and life-long learning are necessary for long-term career success M 5. Belief in using abilities to their fullest to achieve high-quality results and outcomes M 6. Positive attitude toward work and learning Which of the Behavior Standards best align with your plan? (Mark all that apply.) B-LS 1. Demonstrate critical-thinking skills to make informed decisions B-LS 2. Demonstrate creativity B-LS 3. Use time-management, organizational and study skills B-LS 4. Apply self-motivation and self-direction to learning B-LS 5. Apply media and technology skills B-LS 6. Set high standards of quality B-LS 7. Identify long- and short-term academic, career and social/emotional goals B-LS 8. Actively engage in challenging coursework B-LS 9. Gather evidence and consider multiple perspectives to make informed decisions B-LS 10. Participate in enrichment and extracurricular activities B-SMS 1. Demonstrate ability to assume responsibility B-SMS 2. Demonstrate self-discipline and self-control B-SMS 3. Demonstrate ability to work independently B-SMS 4. Demonstrate ability to delay immediate gratification for long-term rewards B-SMS 5. Demonstrate perseverance to achieve long- and short-term goals B-SMS 6. Demonstrate ability to overcome barriers to learning B-SMS 7. Demonstrate effective coping skills when faced with a problem B-SMS 8. Demonstrate the ability to balance school, home and community activities B-SMS 9. Demonstrate personal safety skills B-SMS 10. Demonstrate ability to manage transitions and ability to adapt to changing situations and responsibilities B-SS 1. Use effective oral and written communication skills and listening skills B-SS 2. Create positive and supportive relationships with other students B-SS 3. Create relationships with adults that support success B-SS 4. Demonstrate empathy B-SS 5. Demonstrate ethical decision-making and social responsibility B-SS 6. Use effective collaboration and cooperation skills B-SS 7. Use leadership and teamwork skills to work effectively in diverse teams B-SS 8. Demonstrate advocacy skills and ability to assert self, when necessary B-SS 9. Demonstrate social maturity and behaviors appropriate to the situation and environment What curriculum and materials will you use?Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Process Data: what is the projected number of students affected by this activity? What categories of survey items will you use to document perception data? College Plans Goal Setting Bond with school Student Testing Time Management Responsibility Bullying Academic Self Esteem Student Study Skills Student School Climate Survey Student Learning Confidence Mentor Other Explain "Other." What outcome data will you use to measure success? Attendance Bus Suspensions Discipline referrals Tardies Out of school suspensions In school suspensions Dropouts Enrollment in rigorous courses Participation in extra curricular activities. Detentions Standardized Math Score Standardized Reading Scores ACT Scores SAT Scores Graduation Rate FAFSA Completion Other Explain "Other." Contact Person Do you want to make a fourth plan? Yes No What grade levels will this lesson serve? K 1 2 3 4 5 6 7 8 9 10 11 12 13 Other What is the lesson topic? Please Select the ASCA Mindset Standards that best align with your plan. M 1. Belief in development of whole self, including a healthy balance of mental, social/emotional and physical well-being M 2. Self-confidence in ability to succeed M 3. Sense of belonging in the school environment M 4. Understanding that postsecondary education and life-long learning are necessary for long-term career success M 5. Belief in using abilities to their fullest to achieve high-quality results and outcomes M 6. Positive attitude toward work and learning Which of the Behavior Standards best align with your plan? (Mark all that apply.) B-LS 1. Demonstrate critical-thinking skills to make informed decisions B-LS 2. Demonstrate creativity B-LS 3. Use time-management, organizational and study skills B-LS 4. Apply self-motivation and self-direction to learning B-LS 5. Apply media and technology skills B-LS 6. Set high standards of quality B-LS 7. Identify long- and short-term academic, career and social/emotional goals B-LS 8. Actively engage in challenging coursework B-LS 9. Gather evidence and consider multiple perspectives to make informed decisions B-LS 10. Participate in enrichment and extracurricular activities B-SMS 1. Demonstrate ability to assume responsibility B-SMS 2. Demonstrate self-discipline and self-control B-SMS 3. Demonstrate ability to work independently B-SMS 4. Demonstrate ability to delay immediate gratification for long-term rewards B-SMS 5. Demonstrate perseverance to achieve long- and short-term goals B-SMS 6. Demonstrate ability to overcome barriers to learning B-SMS 7. Demonstrate effective coping skills when faced with a problem B-SMS 8. Demonstrate the ability to balance school, home and community activities B-SMS 9. Demonstrate personal safety skills B-SMS 10. Demonstrate ability to manage transitions and ability to adapt to changing situations and responsibilities B-SS 1. Use effective oral and written communication skills and listening skills B-SS 2. Create positive and supportive relationships with other students B-SS 3. Create relationships with adults that support success B-SS 4. Demonstrate empathy B-SS 5. Demonstrate ethical decision-making and social responsibility B-SS 6. Use effective collaboration and cooperation skills B-SS 7. Use leadership and teamwork skills to work effectively in diverse teams B-SS 8. Demonstrate advocacy skills and ability to assert self, when necessary B-SS 9. Demonstrate social maturity and behaviors appropriate to the situation and environment What curriculum and materials will you use?Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Process Data: what is the projected number of students affected by this activitiy? What categories of survey items will you use to document perception data? College Plans Goal Setting Bond with school Student Testing Time Management Responsibility Bullying Academic Self Esteem Student Study Skills Student School Climate Survey Student Learning Confidence Mentor Other Explain "Other." What outcome data will you use to measure success? Attendance Bus Suspensions Discipline referrals Tardies Out of school suspensions In school suspensions Dropouts Enrollment in rigorous courses Participation in extra curricular activities. Detentions Standardized Math Score Standardized Reading Scores ACT Scores SAT Scores Graduation Rate FAFSA Completion Other Explain "Other." Contact Person Do you want to write a fifth plan? Yes No What grade levels will this lesson serve? K 1 2 3 4 5 6 7 8 9 10 11 12 13 Other What is the lesson topic? Please Select the ASCA Mindset Standards that best align with your plan. M 1. Belief in development of whole self, including a healthy balance of mental, social/emotional and physical well-being M 2. Self-confidence in ability to succeed M 3. Sense of belonging in the school environment M 4. Understanding that postsecondary education and life-long learning are necessary for long-term career success M 5. Belief in using abilities to their fullest to achieve high-quality results and outcomes M 6. Positive attitude toward work and learning Which of the Behavior Standards best align with your plan? (Mark all that apply.) B-LS 1. Demonstrate critical-thinking skills to make informed decisions B-LS 2. Demonstrate creativity B-LS 3. Use time-management, organizational and study skills B-LS 4. Apply self-motivation and self-direction to learning B-LS 5. Apply media and technology skills B-LS 6. Set high standards of quality B-LS 7. Identify long- and short-term academic, career and social/emotional goals B-LS 8. Actively engage in challenging coursework B-LS 9. Gather evidence and consider multiple perspectives to make informed decisions B-LS 10. Participate in enrichment and extracurricular activities B-SMS 1. Demonstrate ability to assume responsibility B-SMS 2. Demonstrate self-discipline and self-control B-SMS 3. Demonstrate ability to work independently B-SMS 4. Demonstrate ability to delay immediate gratification for long-term rewards B-SMS 5. Demonstrate perseverance to achieve long- and short-term goals B-SMS 6. Demonstrate ability to overcome barriers to learning B-SMS 7. Demonstrate effective coping skills when faced with a problem B-SMS 8. Demonstrate the ability to balance school, home and community activities B-SMS 9. Demonstrate personal safety skills B-SMS 10. Demonstrate ability to manage transitions and ability to adapt to changing situations and responsibilities B-SS 1. Use effective oral and written communication skills and listening skills B-SS 2. Create positive and supportive relationships with other students B-SS 3. Create relationships with adults that support success B-SS 4. Demonstrate empathy B-SS 5. Demonstrate ethical decision-making and social responsibility B-SS 6. Use effective collaboration and cooperation skills B-SS 7. Use leadership and teamwork skills to work effectively in diverse teams B-SS 8. Demonstrate advocacy skills and ability to assert self, when necessary B-SS 9. Demonstrate social maturity and behaviors appropriate to the situation and environment What curriculum and materials will you use?Start Date: MM slash DD slash YYYY End Date: MM slash DD slash YYYY Process Data: what is the projected number of students affected by this activitiy? What categories of survey items will you use to document perception data? College Plans Goal Setting Bond with school Student Testing Time Management Responsibility Bullying Academic Self Esteem Student Study Skills Student School Climate Survey Student Learning Confidence Mentor Other Explain "Other." What outcome data will you use to measure success? Attendance Bus Suspensions Discipline referrals Tardies Out of school suspensions In school suspensions Dropouts Enrollment in rigorous courses Participation in extra curricular activities. Detentions Standardized Math Score Standardized Reading Scores ACT Scores SAT Scores Graduation Rate FAFSA Completion Other Explain "Other." Contact Person Additional Notes
