Created by Jennifer Funk, 2012

GOAL #1: _________________________________________________________________________________________________________________

How effective have you been in meeting this goal this week?
Self Rating Description Evidence/Reason
Highly
Effective

The student has demonstrated an active pursuit of achieving
this goal this week, accomplishing this goal for the week as
well as actively seeking assistance from teachers through
proper communication and other support mechanisms like
tutoring, staff resources, ect.

Effective

The student has accomplished his/her goal for the week, but
could have made the experience less stressful if he/she would
have pursued more assistance when needed from a teacher or
staff member and communicated or organized his/herself
more effectively

Minimally
Effective
The student has made attempts at progressing toward his/her
goal this week but is not yet meeting the goal itself

Ineffective
The student has not made a conscious effort to achieve the
goal that he/she created

Do you feel this goal has been met? YES NO If yes explain why
If no, what can you try differently to help improve your progress? Is anything hindering you from accomplishing it?


Write a brief description of what you will do to maintain your progress toward your goal.
Name: Date:
Created by Jennifer Funk, 2012
GOAL #2: _________________________________________________________________________________________________________________
How effective have you been in meeting this goal this week?
Self Rating Description Evidence/Reason
Highly
Effective

The student has demonstrated an active pursuit of achieving
this goal this week, accomplishing this goal for the week as
well as actively seeking assistance from teachers through
proper communication and other support mechanisms like
tutoring, staff resources, ect.

Effective

The student has accomplished his/her goal for the week, but
could have made the experience less stressful if he/she would
have pursued more assistance when needed from a teacher or
staff member and communicated or organized his/herself
more effectively

Minimally
Effective
The student has made attempts at progressing toward his/her
goal this week but is not yet meeting the goal itself

Ineffective
The student has not made a conscious effort to achieve the
goal that he/she created

Do you feel this goal has been met? YES NO If yes explain why
If no, what can you try differently to help improve your progress? Is anything hindering you from accomplishing it?


Write a brief description of what you will do to maintain your progress toward your goal.