INTERVENTION CHECKLIST - School Webmasters



Tier II

SAT Intervention Plan for Academics

Complete one SAT Intervention Plan for Academics for each area of academic concern.

Student:

Date of Plan Initial Follow Up

Reasons for referral: Academic Medical/Health Behavior

|NM Standards & Benchmarks Area: |Grade: |

|Percentage of skills mastered within grade expectancy: |

|Performance is: above expectancy within expectancy below expectancy |

A. FACTORS

Has attendance been a negative factor? *Yes No

Has parent been contacted regarding attendance? Yes No

Date of contact:

Has opportunity for appropriate instruction been a factor? *Yes No

Has language proficiency been a factor? *Yes No

*If identified as factor(s), must address through support plan prior to proceeding to Tier III.

Curriculum/instruction are based on peer-reviewed research: Yes No

Current curriculum of instruction: _______________________________ Principal Confirmation:

B. ACADEMIC INTERVENTION PLAN

|Baseline Data: |

|(Include program/instructional strategies, time, grouping, progress monitoring tool for determining baseline and progress monitoring data) |

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|Target Goal(s): (Including specific skills in measurable terms) |

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|Progress Monitoring: How often will progress monitoring data be collected and graphed or charted? By whom? What measure will be used? |

|Intervention Focus |Support Strategies |Person(s) Responsible |Timeline |

|Program Emphasis | supplement core with re-teaching or intervention component | | |

| |of core | | |

| |replace current core program with intervention program | | |

| |other: | | |

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|Intervention Focus |Support Strategies |Person(s) Responsible |Timeline |

|Time (Opportunity to Learn) | add supplemental instruction period | | |

| |(specify time(s)/week) | | |

| |other: | | |

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|Intervention Focus |Support Strategies |Person(s) Responsible |Timeline |

|Grouping for Instruction |reduce group size down to 3 or fewer students | | |

| |provide individualized instruction | | |

| |other: | | |

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C: PROGRESS MONITORING

|Date of Progress Monitoring |Progress Monitoring Tool |Results |

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|The SAT will meet again on _________/_________/_________ to review this plan |

Status: Mastered, Progressing, Revised, Discontinued

*General Guidance:

If the student has 4 or more progress monitoring data points showing improvement, maintain the intervention program.

If the student has 4 or more progress monitoring data points showing NO or minimal improvement, change the intensity of the program (notify the parent of the intervention change). Data points are determined through weekly progress monitoring. See Levels of Intensity Matrix.

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