School Name	Type here
School Counselor Name	Type here	School Year	Type here
Lesson Title/Topic	Type here
Participants	Type here
Setting – Lesson(s) will be delivered in:	☐ Classroom (Tier 1 whole-class instruction or Tier 2 specific classroom ) ☐ Large Group (grade-level or multi-class instruction) ☐ Small groups (single session delivered to a group of students, ex., junior planning conferences) ☐ Individual (one-on-one student instruction) ex. senior credit checks
Reason for this lesson: Select from each: Life-Readiness – select no more than one category Academic Success - select any category that applies	Life-Readiness ☐ Learning Strategies ☐ Self-Management Skills ☐ Social Skills	Academic Success ☐ Improve academic performance ☐ Meet benchmarks ☐ Improve test scores ☐ Meet promotion/graduation requirements
☐ Single Lesson	☐ Unit of Lessons: Lesson Type here of Type here
Behavior Standard from ASCA Student Standards	Learning Objectives	Pre-/Post-Assessment Statements
Type here	Students will	Type here
Type here
Students will	Type here
Type here

Type here

Administer pre-assessment. Record pre-assessment data. Optional data organizer can be used for this information (baseline data column under Life-Readiness.) Describe how you will:
Introduce lesson and objective:	Type here
Teach content:	Type here
Practice content:	Type here
Summarize:	Type here

END OF PLAN

Lesson Data Report

Participation Data Results
Number of students at beginning of plan:	Type here
Number of students at end of plan:	Type here
If number of students changes from beginning to ending of plan, provide an explanation for the change.	Type here
Graphs If needed, use optional data organizer on the final page to organize the data.
ASCA Students Standards Data Results
Behavior Standard Addressed:	Type here

Insert graph for data from the ASCA Student Standards pre- and post-assessment results for this plan.

What strategies facilitated inclusion and supported diverse learners?	Type here
What components of the lesson could be improved?	Type here

Optional Data Organizer

(Required for RAMP®)

Baseline Participation Data Number of students expected to participate in the lesson:	Final Participation Data Number of students who actually participated in the lesson:
Type here	Type here
Baseline ASCA Student Standards Data	Final ASCA Student Standards Data
ASCA Student Standard Pre-Assessment Results	ASCA Student Standard Post-Assessment Results
Type here	Type here
Type here	Type here
Type here	Type here
Type here	Type here
Baseline Attendance Data (when applicable)	Final Attendance Data (when applicable)
Type here	Type here
Baseline Discipline Data (when applicable)	Final Discipline Data (when applicable)
Type here	Type here %