Request The Survey

Please complete the information below so that we may create your survey. Once your survey is created, we will send your link to the SPBD, and you can then send it to your certificated and classified staff working directly with students.

Please complete the information below so that we may create your survey. Once your survey is created, we will send your link to the SPBD, and you can then send it to your students.

Please complete the information below so that we may create your survey. Once your survey is created, we will send your link to the SPBD, and you can then send it to your certificated and classified staff as well as your students.

Which type of survey would you like to create?

Please provide your contact information:




Please provide information about your school. If you have multiple schools, please fill out separate request forms for each school.











Tell us how many staff work with students in your school. Precise numbers are best for determining response rates; however, if you do not have access to them, please provide your best estimate.

Certificated staff (e.g., teachers, counselors, school psychologists
Classified staff who work directly with students (e.g., paraeducators, librarians, playground supervisors):

Tell us how many students attend your school. Precise numbers are best for determining response rates; however, if you do not have access to them, please provide your best estimate.



If you have Schoolwide Evaluation Tool (SET) or Benchmarks of Quality (BofQ) scores within the past 12 months, please record them here.



SET Total & Domain Scores

A. Expectations Defined: (

B. Behavioral Expectations Taught: (

C. On-going System for Rewarding Behavioral Expectations: (

D. System for Responding to Behavioral Violations: (

E. Monitoring & Decision-making: (

F. Management: (

G. District-Level Support (

Total / Mean



PBIS Team: (

Faculty Commitment: (

Effective Procedures for Dealing with Discipline: (

Data Entry & Analysis Plan Established: (

Expectations & Rules Developed: (

Reward/Recognition Program Established: (

Lesson Plans for Reaching Expectations/Rules: (

Implementation Plan: (

Classroom Systems: (

Evaluation: (

Benchmarks Score: (

Date Completed

Please enter the result percentage for each Tiered Fidelity Inventory tier:
Tier 1
Teams
Implementation
Evaluation
Tier 2
Teams
Implementation
Evaluation
Tier 3
Teams
Implementation
Evaluation

Other data or information related to level of implementation:

How do you intend to use this survey?

Do you anticipate or are you experiencing staff related challenges in implementation? If so, please explain.

I acknowledge that data gathered may be used to validate the technical properties of the SPBD and used to study its application in supporting schools in the implementation of SWPBS. The identity of my school district and school will not be revealed in this process.