Are you looking for an individualized behavior plan that allows your student(s) to pick a reward at two different times during the day?
This is a simple form that can be used as a daily behavior note, to collect behavior data, and help students have a more positive day. I like to use more positive terms, so I tell my students that they need to have success before they can have rewards.
I have included three different versions of the form, so you can use the form that fits your needs the best.