Active Learning Materials and Activities Planning Sheet

Image of Active Learning Materials and Activities Planning Sheet
Image of Active Learning Materials and Activities Planning Sheet

An Active Learning Materials and Activities Planning Sheet might be used to gather information for program planning for a student utilizing an Active Learning approach. Gathering information takes a little time, many conversations with caregivers, some trial and error, and a lot of observation. 

You may download the Active Learning Materials and Activities Planning Sheet blank forms to use with your student.


Sample Planning Sheet

Below is a sample of the Active Learning Materials and Activities Planning Sheet. You may reference this example as you work with your team to complete this form for your student. You shouldn’t expect to complete this form at one meeting or in a few days. This form is meant to help a team get started planning together for their student. As the team continues to learn more about the child, information continues to be added.

These children require close observation and team collaboration if our goal is to build a quality program for them. Don’t rush the team just to fill in all the blanks. Active Learning requires a diagnostic teaching approach: assess, develop and implement  instructional strategies, document progress, reassess, revise instructional strategies. In other words, your team is looking for instructional strategies that work for the individual child. It is important to remember, as the child grows and learns, instructional strategies may need to be revised. So it is important to understand the Dynamic Learning Circle and utilize it as you work with a child using an Active Learning approach.

This document can be shared with a variety of people who interact with the child or who will interact with the child in the future.  It also can be included (in parts) into a portfolio or other records. This form is based on personal notes from a seminar by van Dijk, J. 1985 and information from Dr. Lilli Nielsen in Functional Scheme and some of her other books.

Child’s Name:   David Denton

Date  September 16, 2023          

Likes and Dislikes

Over a period of time (at least 3-4 weeks) through listening to stories from others and through observation of the child, simply list things the child likes and things he doesn’t like. We all enjoy things that we are good at and that we understand. The child’s “Likes” will be his areas of strength and use sensory channels that are working. His “Dislikes” may include aversive materials or experiences, as well as areas of need and sensory channels that may not be working efficiently. The information gathered on this form will give you underlying themes that you can use for identifying objects and activities to use in Active Learning instruction.

Appetite or Likes

Gentle vibration

Music – especially country western

Playing in water (prefers warm water)

Green and blue things

Shiny things or reflective surfaces

Rough textures – sand paper, pan scrubbers, Astroturf

Metal objects

Aversion or Dislikes

Other children crying or screaming

People messing with his feet

Soft or squishy objects

Icky, sticky stuff on his hands or feet

Cold water or cold things like ice, popsicles

Pathways to Learning / Sensory Channels

How well does the child use each sensory channel or pathway? Assign a percentage to each, with 100% being a sensory channel completely intact, and a lower percentage for sensory channel / pathway that the child is not able to use compared to a typically developing peer. Describe the child’s behaviors or known sensory issues that show the reason(s) you recorded that percentage. Check Alerts / Notices or Engages to indicate whether the child alerts to that sensory information or engages in exploration with that sensory channel. Rate the intensity of those sensory channels that are used to actively engage from 1-4 with 1 being mild engagement and 4 being intense engagement. (Example: 50% hearing because child responds to some sounds by laughing or stilling. Alerts to the sound but does not engage or seek to find source of sound.)

Pathway / Sensory Channel



Engages / Uses Sense to Explore

Level of Engagement

  1. mild level
  2. moderate level
  3. high level
  4.  intense level

How do you know?






Always seems to notice objects that are shiny, blue or green. Has CVI so sometimes notices things when in motion.






He is very interested in music, especially country western or things with a predictable beat. He also alerts to funny sounds like slide whistle, whistles, etc. He enjoys movement activities to music. Responds to his name and some very familiar words, but is not using speech. Recognizes familiar environmental sounds like the garage door opening and family voices.






He always alerts to touch from other people. Prefers rough textures to explore with hands, feet, lips and tongue. Is becoming more adventuresome in exploring spaces in hear proximity. He startles and withdraws when presented with things that are cold preferring warm or body temperature items. He does not like soft or squishy objects and withdraws from sticky materials. May fuss if something sticky is not cleaned off quickly.






He has only recently been removed from tube feeding and though he is interested in food he is not highly motivated by it. May prefer sweet things, but not sure as his menu is very limited currently.




There does not seem to be anything wrong with his sense of smell, but we do not see him actively using this sense currently. He may alert to food smells occasionally, but hard to tell.

Proprioception / Movement





He has some paralysis on his right side so he doesn’t use his right arm, hand, leg, or foot to explore currently. However, if objects are presented under right hand or foot he is beginning to show some movement occasionally. He uses his left side very well and loves to move with support, especially dancing or movement to music and rhymes. He sits  unsupported and is beginning to use a gait trainer to move around his home and classroom.

General Questions

Based on this information which channels are most likely to motivate the child to actively engage?

He is very motivated and heavily reliant on tactile information which seems to support his ability to make sense of visual and auditory information. He likes exploring tactually with left hand and foot, mouth and lips. Seems especially interested in rough textures – should expand variety of textures along these lines. He loves to move independently and dancing or movement to music is highly engaging. He might enjoy activities that include bouncing, swinging, spinning…need to explore.

What other challenges need to be addressed to help the child actively engage with these sensory channels? For example, needs to be positioned with support to be able to move arms independently, uses vision when color is red or object is shiny, can hear low frequency sounds best.

Need to encourage movement on right side by placing motivating objects to the right as well as the left. He is moving onto feeding by mouth and may need support to expand items he will taste – offer food items during play to include a variety of textures, tastes, smells. Give plenty of opportunities for him to move independently using gait trainer and also encouraging movement on Support Bench by adding wheels.

What are possible attributes of materials that might appeal to his/her top three sensory channels? (Color, shape, texture, size, sound, flexibility, reflective qualities, movement, etc.)

Clearly adding color and reflective properties to objects could be beneficial. Expand the variety of textures that are less soft and more rough in texture such as tree bark, herbs like rosemary, scratchy materials, sand, pea gravel, grass, sand papers, corrugated cardboard, etc. Perhaps adding texture paper to items that make noise like a drum head or offering things to bang or explore like coconut shells, seed pod rattle, etc. Explore things that move like shiny pinwheels, Christmas decorations, bead strings, mirror on strings, etc. May want to consider using a high contrast background for Position Board, Resonance Board, etc. to reduce visual clutter. Also may want to add musical instruments that make interesting sounds like castanets, bull roarer, slide whistle, Thunder tube, rainsticks, etc.  May include instruments in movement or dance activities – bells on wrist, holding clacker while dancing, etc.

What do you currently observe the child doing with his/her hands (e.g., grab and release, bat at fisted, transfer hand to hand, throwing, scratching)?

Uses left hand (arm) to scratch, grasp, bat, bang, reach, grab and release, but only just beginning to scratch a bit with right hand when objects are presented underneath. 

What do you currently observe the child doing with arms, feet and legs?

Uses left side very well and is beginning to show some small movement on the right side. For example, he will drag his left leg/foot to keep moving in gait trainer. He kicks his left leg when in the Little Room or on the Resonance Board. He will move his feet to play in warm water, though right is more active. Also likes to splash with left hand/arm. Beginning to reach cross midline in Little Room and with Position Board to access desired object. 

What do you currently observe the child doing with his/her head, mouth, lips and tongue?

He is very active in exploring objects with lips, tongue and mouth if he can get the object to them or move to get his mouth on them. He seems to be able to east very soft foods and pureed foods. Just beginning to try finely chopped or lumpy foods. Does not exhibit a good bite or chew yet. Like to like objects and seems to explore shape when he can get them in his mouth.

What kinds of vocal play do you observe? (e.g., babbling, squealing, clicking, etc.)

He vocalizes a lot to music, especially when he is moving with support from someone. He squeals, laughs, makes a number of vowel sounds like eeee, aaaa, ooooo. Plays with pitches and rhythm patterns, and will imitate some when engaged with his mom or dad. Vocalizations increase in Little Room and when vocalizing into tubes, pans, etc.

What sounds does he/she respond to (alerts)? (e.g., dad’s voice, computer generated sounds, door slamming, etc.) What sounds cause the child to try to engage with the sound source, e.g. find what is making the sound, reach for the object, tries to move toward?

He can definitely recognize his mom and dad’s voice when they come to pick him up. He will place his hands on their throats when they sing to him. He loves odd or interesting sounds  and sounds that change pitch quickly like a slide whistle. He will try to get to the gathering drum when it is played during circle time if he is in his gate trainer. He will reach for bull roarer and thunder stick or rainsticks when they make noise near by. 

What kind of scents does he/she like or dislike? (types of smells or particular things that smell)

It is hard to tell. He does like to smell the hand soap when washing up…it has a lemony smell. Should explore some other scents of soap and lotions to see what he might respond to.

What kinds of foods or flavors does he/she like or dislike?

Just beginning to take food orally, and has a limited diet. Seems to prefer sweet things, but eats other food items okay.

What kind of touch does he/she like or dislike?  (e.g., light, heavy, deep pressure, etc.)

He seems to prefer heavy or deep touch to light touch. 

Ideas for Specific Objects to Include in Instruction:

List the items (Lilli says 70 or more) you want to try using and check to see if the properties match the student’s preferences in his/her best sensory channels as identified previously in this form on page 2.  You should consider using multiples of objects with similar but slightly different features. Remember to have a quantity of everyday objects included in the mix.  This can also serve as a shopping list for items you need to find. After you gather these materials use Phases 1, 2, and 3 to narrow introduce them to the child and note what the child is able or interested in doing with each of them.


Vision Hearing Touch Taste Smell Movement
1. Seed Pod Rattle
2. Shiny Pinwheel X
3. Bin of sand with shells and rocks
4. Bin of warm water with pea gravel and shells
5. Bull roarer
6. Rainstick with reflective paper on body
7. Collection of sticks, twigs, leaves, herbs
8. Dry coffee grounds
9. Warmed rice or barley bags
10. Metal pots, pans with rough bottoms to bang
11. Shiny cookie tins and boxes with removeable lids
18. Cardboard boxes, and corrugated cardboard strips
19. Variety of soft food items such as puddings, yogurt, mashed potatoes, baby foods to finger-paint with
64. Elastic strings of metal washers and bolts
65. Metal chains that are various weights and lengths to grasp and move
68. Variety of fuzzy or textured fruits to explore (kiwi, peach, lemon, orange, apple, pear) X X X
69. Collection of wooden wind chimes X X
70.  Guitar, ukulele, other stringed instruments X X

Social and Emotional Development

In order to utilize the best educational approach with your student, what Dr. Nielsen calls the Five Phases of Educational Treatment, we need to look at the child’s behavior.  Look at the behaviors described below and place a P in the row(s) where you see behaviors that are regularly demonstrated by your student. If the child is at a higher level, some of the earlier developmental traits may have disappeared so be sure to review the next level up.


Developmental AgeChild contacts or responds to contact by:Demonstrates
Birth-3 months
        • clutching fingers or some hair of the adult
        • clutching some of the adult’s clothing
        • smacking lips,
        • making “grrr” sounds
        • by nodding, sucking, and grunting
        • can be calmed by being taken in the arms and cuddled
        • transfer of clutching/grasping to biting, pinching may be seen in older children

4-6 months

    • babbling or crying consciously to get adult’s attention or when nothing is wrong
    • may scream or cry most of the day – possible that the screaming is a child’s attempt at babbling
    • may respond to contact by babbling
    • shows anxiety to unfamiliar rooms, persons, toys
6-9 months
        • molding his/her body into the shape of adults
        • snuggles close to the adult
        • touches adult’s face or puts finger in eyes, mouth
        • likes to be moved from the arms of one familiar person to another
        • imitates the adult’s movements, reaches hand toward light switch after adult turns on light
        • seeing Mom or Dad after return causes joy
        • shows joy when recognizing familiar voices
        • may want to move his or her body the way he or she wants to move their body
        • may be pulling their arms away and, kind of, hiding them
        • may want to sit in a specific way
        • if able to be held by an adult, may want to be held or positioned a certain way


9-15 months
        • “showing objects” – wants to share interests with adult
        • if adult does not respond, may attempt to establish contact by hitting the adult with the object (banging objects)
        • refuses contact with persons whom he does not feel attached to
        • puts arms around adult he feels attached to
        • wants to drink from adult’s cup or feed adult
        • laughs and babbles in interactions with adult
        • enjoys adult-learner games such as clapping hands and playing with lips
        • may hit themselves or other people
        • moving to the adult (pull to standing, walking or crawling)
        • acts like he/she wants to sit on adult’s lap, but as soon as he/she gets there, wants to get down
        • may lean against the adult briefly, or rest an arm or a hand on the adult briefly

Describe your general impressions about the individual’s ability to self-regulate, show empathy, manage strong emotions, identify his/her own feelings, read others emotions, and establish and maintain relationships.

He is a happy child who tolerates almost anyone, though he has preferences for family, intervener, bus driver, peer – David. He likes engaging adults. He seldom fusses, but doesn’t like it when other children are crying or shouting. He does not demonstrate any self-injurious behaviors. He enjoys interacting with trusted adults or anyone who will “dance” with him or play movement/rhyming games. If he is fussy it is generally because he is sick or hurting. 

Plan for completing the Functional Scheme:

Decide as a team how and by when you will address all sections of the Functional Scheme.  It is recommended that team members work in pairs on each section for better verification of the student’s use of skills across multiple domains and with multiple people.  Use the chart below to plan who will be responsible for each section.  You may choose the official due date or assign an earlier due date to each section to spread work out across time.  CT=Classroom teacher, Para=Paraeducator.

SectionName and title of participants responsible for section (suggested roles are listed for reference only)Official Due DateTeam assigned due date
Gross MovementPT/COMS10/23 9/23
Fine MovementOT/TVI10/239/23
Mouth MovementOT/SLP10/239/23
Visual PerceptionTVI/COMS10/239/23
Auditory PerceptionTDHH/SLP/TVI10/239/23
Haptic-tactile PerceptionOT/TVI10/239/23
Smell & TasteOT/TVI12/2311/23
Spatial RelationsTVI/COMS10/239/23
Emotional PerceptionCT/Para/Parents12/2311/23
Object PerceptionTVI/CT12/2311/23
Language: Non-verbal



Language: Verbal



Comprehension of Language



Social PerceptionCT/Para/Parents12/2311/23
Perception through Play & ActivityPT/OT12/2311/23
Developmentally Impeding FunctionsCT/Parents10/239/23
Toileting SkillsCT/Para/Parents10/239/23
Undressing and DressingOT/CT/Para/Parents10/239/23
Personal HygieneOT/ CT/Para/Parents10/239/23
Eating SkillsOT/ CT/Para/Parents10/239/23

 Plan for completing the Functional Scheme (cont.):

How will the team share information between team members?

Complete Function Scheme sections and share summary page in Google Drive folder. Team will meet on official due date to confirm results with full team.

How and when will team members discuss discrepancies? Dates/times/locations?

Team will have monthly meetings at the school beginning on 10/1/23 and discuss any discrepancies or changes that need to be made to the Functional Scheme. The Functional Scheme will be updated in December and in May.

Who will go over the assessment with and get information from parent(s)?

TVI, COMS, TDHH, SLP will meet to discuss these areas: visual, auditory, spatial perception and language, daily living skills sections.  They will also cover Developmentally Impeding Functions.

OT/PT/COMS will meet to discuss movement (fine, gross and mouth). They will also cover Perception through Play & Activity.

Classroom teacher will discuss social, emotional, and object perception.

Goals, Objectives, Skills – Data for Child Progress Reporting:

You may find it helpful to have a list of goals/objectives and/or skills that will be the focus of data collection for documenting child progress. You can list them for specific environments and activities and post them near each environment so all staff know what behaviors they should take note of during an observation. Or you may have them in a child’s folder so any staff member can select an environment or activity to observe and collect data. This also could serve as the basis for your lesson plan. Remember, though the child is working on many skills continually, the data collection for IEP purposes focuses on agreed upon goals and objectives. You may list non-IEP related skills in “Other Skills to Watch For”. You may want to check out other types of documentation forms related to specific pieces of equipment.

Environments or ActivitiesGoal/Objective or Skills Child Should Demonstrate# ObservedOther Skills to Watch For# Observed
 HOPSA Dress Explores various surfaces with feet ||||Movement of legs to push or stand |
Position Board (Level 2)Reaches and grasps objects IIIIIIBrings objects to mouth to explore with lips and tongue II
Support Bench
with wheels
Uses both legs and feet to moveII