CICO-SWIS
Point Card Examples
CICO-SWIS Point Card Requirements:
1. Standard for all students
2. Three point Scale (e.g., 0, 1, 2)
3. 3-5 School-wide Expectations
4. Up to 10 Check in times
Early Childhood Example
Name: ____________________________ Points Goal:
Date: _____________________________ Points Earned:
= 2
Points
= 1
Point
= 0
Points
Expectation
Period 2
Period 3
Safe
Respectful
Responsible
Staff
Initials
Total
Points
Goal Reached? Yes No
Teacher Signature: ___________________________________________________________________
Comments: ________________________________________________________________________
Elementary School Examples:
HAWK Report – Helping A Winning Kid
Name: Points received
Date:
Daily Goal _____ Daily goal reached? Yes No
GOALS
Period 1
Period 2
Period 3
Period 4
Period 5
Period 6
Be Safe
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
Be
Respectful
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
Be
Responsible
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
TOTAL
H.U.G.
(Hello, Update, Goodbye)
Name: __________________________________ Date: _______________________
Please indicate whether the student has met the goal during the time period indicated.
Meets: (2 points) So, so: (1 point) Doesn’t meet: (0 points)
Goals
AM to Lunch
Lunch
Recess
PM
Be Safe
Be Kind
Be Responsible
Total Points
Teacher Initials
HUG Daily Goal _____/18 HUG Daily Score _____/18
Teacher Comments: Please state briefly any specific behaviors or achievements that demonstrate the
student’s progress.
Parent’s Signature and Comments:
School Name
Check In Check Out (or other name of program i.e. “PAWS”)
Student name:____________________________ CICO mentor:________________________ Date:________________
Expectation #1
Expectation #2
Expectation #3
Total Points
Teacher Initials
Period 1
0 1 2
0 1 2
0 1 2
Period 2
0 1 2
0 1 2
0 1 2
Period 3
0 1 2
0 1 2
0 1 2
Period 4
0 1 2
0 1 2
0 1 2
Period 5
0 1 2
0 1 2
0 1 2
Period 6
0 1 2
0 1 2
0 1 2
Period 7
0 1 2
0 1 2
0 1 2
Period 8
0 1 2
0 1 2
0 1 2
Key:
2 points
Behavior was appropriate; student managed his/her own behavior.
1 point
Behavior was somewhat appropriate; student needed one reminder.
0 points
Behavior was inappropriate; student continued problem behavior after reminder(s).
Middle School Examples:
Daily Progress Report
Name _____________________ Rating Scale Points Possible _______
Date_______________________ 2=Great Goal to meet_______
1=Sort of Points received_____
0=Try Again Goal Met Yes No
Goal
Period 1
Period 2
Period 3
Period 4
Period 5
Period 6
Period 7
Be Safe
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
Be
Responsible
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
Be
Respectful
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
TOTAL
Comments
Parent/Guardian Signature
Middle School
Check & Connect Card
Name: Points received
Date:
Daily Goal _____ Daily goal reached? Yes No
Goal/
Period
Be Responsible
Be Respectful
Do Your Personal
Best
Period 1:
0 1 2
0 1 2
0 1 2
Period 2:
0 1 2
0 1 2
0 1 2
Period 3:
0 1 2
0 1 2
0 1 2
Period 4:
0 1 2
0 1 2
0 1 2
Period 5:
0 1 2
0 1 2
0 1 2
Period 6:
0 1 2
0 1 2
0 1 2
High School Examples:
Oregon High School
Name _____________________________________ Points: _____________
CLASS
Perseverance
Respect
Integrity
Discipline
Excellence
Teacher
initial
1
st
period
_________
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
2
nd
period
_________
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
3
rd
period
__________
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
4
th
period
_________
0 1 2
0 1 2
0 1 2
0 1 2
0 1 2
Parent / Guardian signature_______________________________
Comments? Questions?
_____________________________________________________________________________________
California High School
Name _____________________________________ Points: _____________
Goals
1/5
2/6
3/7
4/8
Total
Points
Be Respectful
0 1 2
0 1 2
0 1 2
0 1 2
Be Responsible
0 1 2
0 1 2
0 1 2
0 1 2
Follow
Directions
0 1 2
0 1 2
0 1 2
0 1 2
Be There & Be
Ready
0 1 2
0 1 2
0 1 2
0 1 2
Comments:
____________________________________________________________________________________
Sample High School Daily Progress Report
Check-In/Check-Out Form - Daily Progress Report
Name: __LaVonne Walker______ Date: __10/15/15_________________
Teachers: Please indicate Yes (2), So-So (1), or No (0) regarding student’s achievement for the
following goals today.
Daily Goal: % Daily Score: %
Teacher comments: Please state briefly any specific behaviors or achievements that demonstrate the
student’s progress.
Period 1/5 Behavior is improving!
Period 2/6
Period 3/7 Thanks for your great focus today _____________
Period 4/8
Goals
Period 1/5
Period 2/6
Period 3/7
Period 4/8
Be There
2
2
2
1
Be Ready
1
1
1
2
Best Effort
2
1
2
1
Homework
Complete
1
0
1
0