School-Based Horticultural Therapy Note (IEP/504-Aligned)

Student Name: [Student name]

DOB: [Date of birth] Grade: [Grade level] School: [School name]

Plan Type: [IEP / 504 / Both]

Session Date: [Date] Time: [Start–End] Duration (minutes): [Total minutes]

Location: [Session location]

Delivery Model: [Individual / Group of (number) / Push-in / Pull-out] (If group, include size as number only; never identify other students)

Provider: [Name, credentials]

Session Context

[Purpose linked to educational participation; attendance status; relevant contextual factors affecting performance] (1–3 sentences. If no notable context: "Session proceeded as scheduled.")

IEP/504 Alignment

Goals Addressed:

• [Goal #/Domain]: [Session target] (One line per goal targeted)

Accommodations/Modifications Used: [List only those actually implemented this session] (Omit if none used)

(If IEP/504 not available: "IEP/504 not available; intervention targeted observed needs consistent with service area.")

Intervention & Response

[Horticultural activity and skilled therapeutic purpose; supports/prompting provided; measurable response data including accuracy, engagement duration, prompt level, frequency counts as relevant; barriers encountered and effective strategies] (Integrate activity description with performance data for each goal area. Include safety concerns with objective description and response taken only if applicable.)

Assessment

[Synthesis of session observations anchored to specific behaviors; progress signal if comparative data exists: improving / stable / regressing; what appeared to drive performance; accommodation effectiveness] (2–4 sentences. Use qualifying language such as "appeared" or "suggests" when inferring beyond direct observation.)

Plan

Carryover Recommendations: [Concrete strategies for teachers/caregivers specifying who, what action, and with what supports] (1–3 recommendations)

Next Session: [Planned focus linked to IEP goal(s); activity progression or modification trials; what will be measured]

(If minutes not fully delivered, note make-up plan. For concerns warranting IEP/504 review, use: "recommend team consideration of...")

Provider Signature: [Signature] Date/Time Signed: [Date and time]

(Omit any section that does not apply. Use "Not documented" for required fields where information is unavailable.)