Weekly Momentum Tracker Form
Weekly Momentum Tracker
Check-In / Check-Out (CICO) • Daily Habit & Goal Progression
Weekly Target: %
Student:
Week Of:
CICO Coach:
Core Target Expectations
Rating Scale: 2 Great / Fully Met 1 Reminder Needed 0 Did Not Meet
Goal 1: Respect & Regulation
Respectful words/actions, safe body, accepts adult feedback peacefully.
Goal 2: Prepared & Engaged
Arrives on time with tools, ready to start, active listening during instruction.
Goal 3: Task Effort & Advocacy
Works through independent time, attempts tasks, raises hand for help.
Day / Check-In
Block 1 / AM
Block 2 / Mid
Block 3 / PM 1
Block 4 / PM 2
Check-Out / Total
Mon AM Check
Goal: % Initials
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
Pts: ___ / 24 ___ %
Goal Met? Y N
PM Coach:
Tue AM Check
Goal: % Initials
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
Pts: ___ / 24 ___ %
Goal Met? Y N
PM Coach:
Wed AM Check
Goal: % Initials
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
Pts: ___ / 24 ___ %
Goal Met? Y N
PM Coach:
Thu AM Check
Goal: % Initials
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
Pts: ___ / 24 ___ %
Goal Met? Y N
PM Coach:
Fri AM Check
Goal: % Initials
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
G1G2G3
2 2 2
Teacher:___
Pts: ___ / 24 ___ %
Goal Met? Y N
PM Coach:
Total Points ____ / 120
Weekly Score ____ %
Days Goal Hit ____ / 5 Days
Reward Earned? [ ] Yes [ ] Next Week!
Weekly Focus Strategy:
Page 1 of 2 • Daily Log
Weekly Momentum Review
Visual Growth • Academic & Behavior Habits • Team Reflection
Friday Wrap-Up Date:
Daily Performance Visualizer
Color up to your daily % score each afternoon
100% 50%
Mon Score: ___%
100% 50%
Tue Score: ___%
100% 50%
Wed Score: ___%
100% 50%
Thu Score: ___%
100% 50%
Fri Score: ___%
Dotted line represents 80% Tier 2 CICO Success Threshold
Weekly Habit Self-Audit
Consistently (3) Sometimes (2) Growth Area (1)
Attendance & Pacing: Arrived on time to all blocks; transitioned smoothly between classes.
Tool Preparedness: Had pencil, notebook, charged device, and materials ready immediately.
Respectful Communication: Used positive tone with peers/staff; regulated frustration appropriately.
Self-Advocacy & Help-Seeking: Asked clarifying questions or signaled teacher when stuck.
Assignment Completion: Stayed on-task through independent practice and submitted work.
My Biggest Win This Week:
What went really well? What strategy helped you succeed?
My Adjustment for Next Week:
When did things get tough? What strategy will you try next?
Team Sign-Off & Caregiver Communication
Student Signature
"I am proud of my effort this week."
CICO Coach Note & Signature
Weekly Goal: [ ] Achieved [ ] Progressing
Parent / Guardian Signature
Date reviewed: ________________
Tier 2 PBIS Behavioral & Academic Intervention Tool Page 2 of 2 • Weekly Wrap-Up