Documentation of Instruction and Interventions

TIER I
Participation in
Core
Curriculum

Interventions/Implementer(s)

Description of
students participation
in core curriculum
(Include amt of time,
mode of instruction,
curriculum, etc.)

Intervention/Program
s

Frequency/Duratio
n

(Describe)

(Example: 30 min 3x
week for 10 weeks)

Reading

She is reading at a
second grade
level.

We will begin reading

tutoring.

Math
Reasoning

She is counting
numbers on a first
grade level.

We will begin math

tutoring.

She is involved in
a lot of drama.

We will set personal

goals and track the
achievements.

The reading tutoring

will be twice a week
for thirty minutes
over a six week
period.
The math tutoring
will be twice a week
for thirty minutes
over a six week
period.
We will meet 10
minutes per day over
a nine week period.

Area

Behavior

Fidelity of
Intervention

Results:

Rate of Progress

(Qualification of
interventionist,
adherence to
program attendance
rates)

Provide quantitative
(systematic progress
monitoring data) and
qualitative information.

(as compared to grade

level peers)

This will be
performed by a
highly qualified
teacher.

She improved over

the time frame.

She is still below

grade level
expectations.

This will be
performed by a
highly qualified
teacher.

She improved slightly.

She is still below

grade level
expectations.

This will be
performed by a
highly qualified
teacher.

She improved over

the time frame.

She is still below

grade level
expectations.

We recommend that the student will continue receiving interventions.

Documentation of Instruction and Interventions, continued

TIER II
Participation in
Core
Curriculum

Area

Description of
students
participation in core
curriculum (Include
amt of time, mode of
instruction,
curriculum, etc.)

Interventions/Implementer(s)

Intervention/Program
s

Fidelity of
Intervention

Results:

Rate of Progress

The guardians will be

required to sign logs
that confirm the
student read for
twenty minutes each
day for four days
each week. The
student will work on
Istation twice a week
for thirty minutes
each day.
She will do Moby
Max thirty
minutes/day for three
days each week. She
will participate in
small groups three
days/week for ten
minutes.
She will begin
meeting with the
school counselor
twice a week for
fifteen minute
sessions.

This will be
confirmed and
monitored by a
highly qualified
teacher.

She was at a 2.0-3.0

level. Now, she is at
a 2.3-3.3 level.

She is still below

grade level to her
peers, but she is
improving.

This will be
confirmed and
monitored by a
highly qualified
teacher.

The students recall

is improving.

She is below grade

level in comparison
to her peers,

This will be
confirmed and
monitored by a
highly qualified
teacher and the
counselor.

She has began

having better days.
Her rate of turning in
work is now at 60%
in comparison to the
previous 20%.

She is below grade

level in comparison
to her peers,

(Describe)

Reading

Her reading is
slightly
improving.

We will begin weekly

reading logs, Istation
and assigned reading at
home.

Math

She is failing to
recall new
important
information.

We will begin using

Moby Max and small
group intervention
during Daily Five time.

She is constantly
tardy, aggressive
in response to
adults and
doesnt turn in
her assignments.

She will be assigned a

positive mentor. We will
work on positive oneon-one interactions. We
will also set new
personal goals.

Behavior

Frequency/Duratio
n

We recommend the student to continue receiving necessary interventions.

Documentation of Instruction and Interventions, continued

TIER
Participation
in
Core
Curriculum

Area

Reading

Math
Reasoning/
Computation
Behavior

Description of
students
participation in
core curriculum
(Include amt of
time, mode of
instruction,
curriculum, etc.)

Interventions/Implementer(s)

Intervention/Progra
ms

Frequency/Durati
on

Fidelity of
Intervention

Results:

Rate of Progress

(Describe)

She has
difficulty
sequencing
events.

We will do individual
one-on-one
sequencing on three
sentence stories. We
will gradually
increase the story
lengths.

We will do this
thirty minutes each
day for four days
each week over an
eight week period.

This will be
completed by a
highly
qualified
teacher.

She made slight

improvements.

She is having
trouble with
math
computations.

We will do small
groups and one-onone intervention.

She has an
inability to feel
successful
which has led
her to focus
more on drama
with her
classmates.

She will work one-onone with the

counselor.

We will do this
thirty minutes each
day for five days
each week over a
six week period.
We will do this
thirty minutes each
day for two days
each week over a
nine week period.

This will be
completed by a
highly
qualified
teacher.
This will be
completed by
the school
counselor.

She made
improvements and
showed a
substantial amount
of effort.
Her behavior has
become more
positive.

She started with

three sentence
stories. Her goal
is twelve or more
sentence stories.
She completed
ten sentence
stories.
Her current level
is 25, and her goal
level is 85.
She is now
interacting
appropriately
according to her
age.

Student Success Team Considerations/Deliberations/Analysis/Recommendations

We recommend that the student continue working with the teacher. We also believe the student will benefit from continued counseling
sessions.