1. DATE# OF OCCURRENCES ADDITIONAL COMMENTS Frequency Data Collection Form Name: ____________________________________________ Target Behavior: ____________________________________ 11/21/20151 West Virginia Autism Training Center

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3. 11/21/2015West Virginia Autism Training Center3 Behavior Counting X out each time behavior occurs Name _____________________________Week of ________________________ Behavior to be counted _____________________________________________ Monday 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Tuesday 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Wednesday 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Thursday 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Friday 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

4. Child’s Name: ______________Week of: _________________ Behavior:_______________________________________ Check the number of times the behavior occurs during the activity.. ActivityMon.Tues.Wed.Thurs.Fri.Average Arrival ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___510times ___10-15 ___15-20 ___+20 Circle ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 Lunch ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 Average ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20 ___0 times ___1-5 times ___5-10times ___10-15 ___15-20 ___+20

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