School Counselor:	Type here
School:	Type here
School Year:	Type here

Share these documents and discuss significant information with the principal and administrators in charge of the school counseling program. ASCA Student Standards Delivery Plan Achievement Gap Plan

The following achievement gap goal(s) will be addressed (from achievement gap plan).
1.	Type here
2.	Type here

Previous school year Average of two use-of-time 5-day calculators from previous year.
Recommended 80% or more	20% or less	Non-school-counseling duties
Direct student services	Indirect student services	Program planning activities	Fair-share school support activities
Type here %	Type here %	Type here %	Type here %	Type here %
Planned Use-of-Time for Current Year Indicate your planned time allocations for this school year
Recommended 80% or more	20% or less	Non-school-counseling duties
Direct student services	Indirect student services	Program planning activities	Fair-share school support activities
Type here %	Type here %	Type here %	Type here %	Type here %

The American School Counselor Association’s recommended ratio is one school counselor per 250 students (1:250). I am ☐ Full Time ☐ Part Time _______ students My Ratio One school counselor Type here students My Caseload (choose one) ☐ All Students Number of students: Type here ☐ Alpha Last names beginning with: Type here to Type here ☐ Grade Level Students in grades: Type here ☐ Other Describe Type here

The school counseling advisory council will meet to provide feedback and input on the school counseling program.
First Semester Meeting Date:	Type here
Second Semester Meeting Date:	Type here
Proposed Members: (names and member position)	Name	Position
Type here	Type here
Type here	Type here
Type here	Type here
Type here	Type here
Type here	Type here

I plan to participate in the following professional development based on my professional needs and/or professional standards from the ASCA School Counselor Professional Standards & Competencies checklist.
Date(s)	Topic	Cost
Type here	Type here	Type here
Type here	Type here	Type here
Type here	Type here	Type here
Type here	Type here	Type here

Group	My Role	Timeframe
Type here	Type here	Type here
Type here	Type here	Type here

List any presentations you make to local, state or national events below.
Audience	Title of Presentation	Date
Type here	Type here	Type here
Type here	Type here	Type here

Materials and supplies needed:	Type here
Annual budget:	$ Type here

The school counseling office will be open for students/parents/teachers from:	Type here to Type here (if flexible scheduling is used)
My hours will be:	Type here to Type here (if flexible scheduling is used)
The career center will be open from:	Type here to Type here

Choose all that apply.

Role/Responsibility	Person Assigned (no signature required) or NA
School Counseling Department Assistant	Type here
Attendance Assistant/Clerk	Type here
Data Manager/ Registrar	Type here
College and Career Center Assistant	Type here
Other Staff	Type here
Type here
Type here
Volunteers	Type here
Type here
Type here
Type here

Must be within the first two months of school.
Printed Name	Signature (in blue or black ink)
School Counselor:
Type here
Principal:
Type here
Administrator in charge of the school counseling program: (if different from principal)
Type here
First Day of School	Type here
Date of Conference	Type here

Minutes from Administrator Conference

Type here