T-1

ALBUQUERQUE PUBLIC SCHOOLS

STUDENT ASSISTANCE TEAM

Initial Teacher Referral for SAT Meeting

Academic Behavioral Language Speech

Reading Voice

Written Language Fluency

Math Articulation

Student Name: Gallegos Student ID #: 9700 Grade: 6

Teacher Name: Hernandez Interpreter Needed Yes No Language ENGLISH

Note: If a teacher receives an independent evaluation submit to SAT Chair immediately.

The following steps must be completed before you can request a Student Assistance Team meeting.
It is imperative that all academic areas of concern be addressed before scheduling a SAT meeting.

Step 1 N/A English Language Learners (ELL) a Language Usage Data form must be
completed for any student that is classified as PHLOTE (4.9 or below on Access) unless
the student is classified FEP or Advanced or Proficient (Versafit Program Tab)
R-11 Language Usage Data Form
R-12 Menu of Effective Sheltered Instruction
R-13 Parent Guardian Interview English/Spanish
R-14 Cultural Impacts and Learning Environment

Step 2 Enter Classroom Teacher Tier I Results for Area(s) of Concern

Reading
Tier 1 Intervention Results for Elementary Yes N/A
The student completed 6 weeks of a Tier 1 intervention starting on enter date, ending on enter date.
The teacher provided name of strategy using name of program to improve reading skills. Progress
monitoring results are as follows: Week 2 enter results, Week 4 enter results, and Week 6 enter
results. The student choose item using the Tier 1 intervention.

Tier 1 Intervention Results for Secondary Yes N/A

The student completed 6 weeks of a Tier 1 intervention starting on 10/7/16 ending on till current.
The teacher provided weeekly vocabulary words and tiered assessment to improve reading skills.
The student has a current grade of 29% (F) in Langauge Arts, turns in 36.1%% of their work, and
has a testing average of 23%. The student is not making adequate gains using the Tier 1
intervention.

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Writing
Tier 1 Intervention Results for Elementary Yes N/A
The student completed 6 weeks of a Tier 1 intervention starting on enter date, ending on enter date.
The teacher provided name of strategy using name of program to improve writing skills. Progress
monitoring results are as follows: Week 2 enter results, Week 4 enter results, and Week 6 enter
results. The student choose item using the Tier 1 intervention.

Tier 1 Intervention Results for Secondary Yes N/A

The student completed 6 weeks of a Tier 1 intervention starting on 10/17/16, ending on Current.
The teacher provided daily writing prompts and essays to improve writing skills. The student has a
current grade of 29% in Langauge Arts, turns in 23%% of their work, and has a testing average of
36.4%%. The student is not making adequate gains using the Tier 1 intervention.

Math
Tier 1 Intervention Results for Elementary Yes N/A
The student completed 6 weeks of a Tier 1 intervention starting on enter date, ending on enter date.
The teacher provided name of strategy using name of program to improve math skills. Progress
monitoring results are as follows: Week 2 enter results, Week 4 enter results, and Week 6 enter
results. The student choose item using the Tier 1 intervention.

Tier 1 Intervention Results for Secondary Yes N/A

The student completed 6 weeks of a Tier 1 intervention starting on 4/1/17, ending on Current. The
teacher provided mobymax math to improve math skills. The student has a current grade of F (7%)
in Mathematics, turns in 0% of their work, and has a testing average of 7%. The student is not
making adequate gains using the Tier 1 intervention.

Behavior (You will need to complete R4e in order summarize your results here).
Tier 1 Intervention Results for Elementary/Secondary Yes N/A
The behavior of concern is unable to stay on task and refuses to follow instructions. The student
is refusing to work in class, will not follow rules and defiant behavior to authority. Teacher(s)
monitored the behavior through a scatterplot lasting one consecutive week. The behavior occurred 50
times during 1st period in Mathematics classroom. The teacher has determined that the student is
not responding to the classroom management plan of describe the classroom management plan
that was used and is in need of an FBA/BIP.

Step 3 Request Student Health Record Review by Nursing Services (Provided by school Nurse)

Step 4 Print Versafit Tabs (Attendance, Schedule, Enrollments, Programs, Test Scores, Student History)

Step 5 If referring for Speech and/or Language, complete R7d1, R7d2 up to Summary of
Concerns.
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Step 6 Turn in T1 documentation to SAT Chair.

SAT Chair assigns Student Assistance Team (SAT) meeting. Date of Meeting: .

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