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To record your meeting, complete the information below and then click the "Submit" button at the bottom of the form. Fields with * are required to have an entry.

Important Data Entry Note: Copying and pasting into the fields below from Microsoft Word may cause an error when submitting. This is due to the hidden characters Word inserts into the text formatting. If you get an error message, you can try removing the text formatting in your Word document (e.g. bold, italics, bulleted/numbered lists) before cutting and pasting. If you continue to get an error message, you may need to type the information directly into this form.

ABC-UBI Systems Team Meeting Agenda & Submission Form for 2011-2012

Team Name*

Meeting Date*
(ex. 08/27/2011)

Times must be entered in the following format: hh:mm PM/AM ex. 08:30 AM
uppercase AM or PM must be entered

Time Started*

(ex. 01:00 PM) 		Time Ended*

(ex. 02:34 PM)
Meeting Attendance
(list names next to corresponding roles)
Administrator*
Facilitator*
Note Taker*
Data Analyst*
Time Keeper*
Active Team Members* (list names of additional team members attending this meeting)
Check if present at meeting: District Coach    State Contact
Meeting Preparation
Check all items that were brought to the meeting
Agenda
Previous Meeting Notes
Data Summary 		Ensure that essential roles are covered for meeting functioning
Problem Solving Flipbook
Review*: Meeting notes and tasks from last meeting (5-10 minutes)
Systems Level Data Sources:
Check all data sources that were used during the meeting for descision-making
Office Discipline Referrals/Majors
     (select type: Number Totals  Graphs)
Positives
    (select type: Number Totals  Graphs)
Supplemental Behavior Data
    (if used also check type : Number Totals   Graphs)
Supplemental Academic Data
    (if used also check type: Number Totals   Graphs )
Survey Level Academic Data
Benchmark Data
Parent, Teacher, Student Surveys
Other     Describe:

Target: (20-30 minutes)
1. Follow the four-step problem solving process
    a. What is the problem?
    b. Why is it happening?
    c. What should be done?
    d. Did it work?
2. Utilize monthly data summary and other data routinely collected to maintain focus on predictable systems failures and emerging needs.
3. Look to your guiding questions and problem solving considerations in flip book if your team get stuck in the process.
4. More than one problem can be discussed during the meeting, you may be at different steps in each problem.

Target Summary Notes*:
Next Steps*: Assign tasks to team members and determine how progress on long-range activities will be evaluated (5-10 minutes)
List what the task entails, who is reponsible, & when the task is due
Next Meeting Date*
(ex. 08/27/2009)		 Next Meeting Location*

To erase all the information on this form, click "Reset".
To submit, click the "Submit" button ONCE and WAIT for the information to be processed. Once the data has been submitted successfully you will be forwarded to a new web page where you can view and print the submitted data.

Contact Loydene Berg for technical assistance
loydeneb@updc.org