ASE ENVIRONMENT-PERSON MAP (EPM)
The ASE Academy — intern-resources.html
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Counselor: ___________________  Date: ___________  Grade/Age: ____
Setting: ____________________  Referral Source: ___________________

PART 1 — ENVIRONMENTAL MAPPING
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CONSTITUTIONAL GOVERNOR
(Biological, neurological, developmental, and physical conditions)

Developmental stage and age-typical considerations:
[describe what is developmentally probable and what varies for this student]


Neurological/sensory profile (if known):
[sensory sensitivities, attention patterns, regulatory baseline, health factors]


Physical environment of the school:
[space, noise, schedule demands, movement, light — what does the body encounter here?]


Student's regulatory baseline as observed:
[ ] Tends toward activation/dysregulation
[ ] Variable — context-dependent
[ ] Generally settled/available

Notes:


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CULTURAL GOVERNOR
(Shared meanings, expectations, histories, and practices)

Student's cultural identities and community contexts:
[race, ethnicity, language, faith, neighborhood, family structure — name what is known]


Family's relationship to schooling and authority:
[how has this family experienced schools? What does help-seeking mean culturally?]


Peer and social culture relevant to this student:
[what are the social norms that shape this student's daily experience?]


School's cultural climate as it affects this student:
[whose knowledge is valued here? How is difference treated? What is the implicit
message about this student?]


Cultural distance between home and school:
[ ] Minimal      [ ] Moderate      [ ] Significant
Notes:


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CIRCUMSTANTIAL GOVERNOR
(Specific, time-bound conditions present right now)

Recent significant events or transitions:
[losses, moves, family changes, academic events, peer conflicts — what has happened?]


Ongoing stressors:
[housing, food, family illness, legal system involvement, work obligations, bullying]


Circumstantial resources and protective factors:
[what is available right now that supports this student?]


Urgency:
[ ] Low — manageable      [ ] Moderate — requires monitoring
[ ] High — requires immediate attention


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PART 2 — PERSON-ENVIRONMENT INTERACTION

What is this environment producing for this student?
[How are the three governors interacting to produce what you observe? What does the
environment make probable, possible, or impossible for this person?]




What strengths and capacities are visible within these conditions?
[Which of the 5Cs are most developed? What does this student do well, within their ecology?]




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PART 3 — INTERVENTION PLANNING

Individual-level goals (person):
[What capacities will you cultivate? Use 5Cs as a map.]
1.
2.
3.

Environmental advocacy targets:
[What does the school, classroom, or family environment need to change or provide?]
1.
2.

Consultation indicated with:
[ ] Teacher  [ ] Family  [ ] MDT  [ ] Community agency

Referral indicated: [ ] Yes  [ ] No     If yes, to:


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PART 4 — REFLECTIVE NOTES (for supervision)

What am I most uncertain about in this conceptualization?


Which governor do I know least about, and how will I learn more?


What in my own formation might be shaping what I see here?


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