REINFORCEMENT SURVEY

Child: Informant:

Date:

INTEREST LEVEL

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Art Project
Cooking
Dancing
Drawing
Dressing in Costume
Extended Bedtime
Field Trip
Going for Walk
Library Time
Lotion
Pace Painting
Painting
Parties
Perfume
Picnic
Playing a Musical Instruments
Ride in Car
Singing
Wearing Jewelry
Working with Tools
Working with Clay

ACKNOWLEDGEMENT

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Call Home
Certificates
Citizen of Week
Class Announcement
Good Behavior Coupons
Happy Faces on Paper
Lunch with Parent
Lunch with Teacher
Lunch with Principal
Money
Name on Board
Papers Posted
Pins
Points
Ribbons
Stamps on Hand
Star on Chart
Stickers
Tokens

FOODS

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Carrots
Celery
Cereal
Cheese
Cookies
Crackers
French Fries
Fruit
Fruit snack
Graham Crackers
Gum
Jello
Juices
Marshmallows
Nuts
Popcorn
Popsicles
Potato Chips
Pretzels
Pudding
Raisins
Soft Drinks
Trail Mix
Yogurt

GAMES

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Candy Land
Cards
Checkers
Chess
Clue
Computer Game
Happy Hippo
Marble Maze
Monopoly
Puzzles
Scrabble
Shoots & Latters
Uno

GAMES SOCIAL

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Capture the Flag
Catch
Chase
Dodge Ball
Duck Duck Goose
Four Square
Hide & Seek
Jump Rope
Pickle
Red Rover
Ring Around the Rosie
Tag
Tug of War

HELPER

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Arrange Bulletin Board
Audio Visual Helper
Cafeteria Helper
Chalk Board Eraser
Choice of Seats
Clean Chalk Board
Collecting Papers
Correcting Papers
Custodian Helper
Door Closer
Feeding Classroom Pet
Flag Holder
Flag Raiser
Hall Monitor
Line Leader
Office Clerical Work
Office Monitor
Passing Out Papers
Peer Tutor
Phone Answerer
Plan Daily Schedule
Playground Helper
Pledge of Allegiance Leader
Running Errands
Sharpen Pencils
Special Job
Turn Lights On/Off
Watering the Plants
Window Opener

MEDIA

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Books
Computer
Electronic Game
Game Boy
Listening to Radio
Magazines
Playing CD/Tape
Taking a Picture
Tape Recorder
Type Witting
View Master
Watching TV
Watching Video

SOCIAL REINFORCERS

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Being Picked Up
Clapping
Complimentary Comment
Hand on Shoulder
Head Nod
High Five
Horsey Ride
Hug
Kissing
Massage
O.K. Sign
Rubbing Hair
Rubbing Head
Shaking Hands
Smile
Thumbs Up
Tickling
Verbal Praise
Wink

SPORTS

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Baseball
Basketball
Bike Riding
Climbing
Football
Four-Square
Golf
Gymnastics
Hand Ball
Jogging
Ping Pong
Rings/bars
Roller Blading
Roller Skating
Skate Boarding
Soccer
Street Hockey
Surfing
Swimming
T-Ball
Tennis
Tether ball
Volley Ball

SUSPENDING RULES

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Call Teacher by First Name
Chewing Gum
Choice of Seats
Early Lunch with Entire Class
Early Lunch with Friend
Eating Lunch in Classroom with Friend
Engage in Self Stimulation
Exempt from Non-preferred Activity
First in Line
Free Time
No Homework
No Chores
One-to-One Time
Select Chore
Sit on Table
Sit in front
Sit next to windows
Sit wherever desires
Sit in Back of Room
Sit next to door
Taking Extra Recess Time with Friend
Taking Soda Break
Taking Extra Recess

Time with Entire Class
Talk Loudly
Working with Shoes Off
TOYS

REINFORCERS	NONE	LOW	MEDIUM	HIGH
Action Figures
Balloons
Barbie
Beads
Bean Bags
Blocks
Busy Box
Cars
Cartoon/Movie Figures
Dolls
Duplo
Fans
Flashlight
Flome
Gack
Jacks
Kaleidoscope
Legos
Lincoln Logs
Marbles
Models
Musical Instruments
Pin Wheel
Play Dough
Sand Toys
See & Say
Shape Sorter
Silly Putty
Slinky
Stress Ball
Stuffed Animals
Tops
Toy Guns
Trains
Transformers
Trucks
Vibrating Toy
Whistles
Yo-Yo