Name: ____________________________
Age: ______________________________
School: ____________________________ [Fill in the relevant details]
Any previous history of behavioral problems: ____________________________________________________________________________________________________________________________________________________________ [Mention if the child has shown any previous display of unnatural emotional or psychological trauma or outburst]
Performance in school and interaction with peers: ____________________________________________________ [Provide details of the student’s academic performance, learning abilities and interactions with classmates or peers in order to pinpoint any abnormalities in behavior]
Any prior history of learning disabilities or medical concerns: ______________
[Mention any such history in order to explain or identify the source of a child’s behavioral imbalances]
Siblings, if any: _______________ [Give the relevant detail]
Download Student Functional Behavior Assessment Template In Word Format