LEA Response to Intervention (RtI) Assurance Form



LEA Response to Intervention (RtI) Assurance Form

Please complete and return by November 18, 2013

Email: mwalton@mail.

Fax: 518-474-8299

In compliance with sections 100.2(ee)(7) and 100.2(ii) of the Regulations of the Commissioner of Education, the _____________________________________ (fill in)

School District hereby provides assurance that:

1. The school district is operating a Response to Intervention program consistent with the requirements of section 100.2(ii) of the Regulations of the Commissioner of Education. Effective July 1, 2012, all schools with grades K-4 must now be providing RtI programs in the area of reading (no assurance form required). Please include only other grade levels and subject areas on this form.

2. The RTI program is available at the grade levels and subject areas (reading/math) for which students are identified as eligible for AIS.

3. All students who are otherwise eligible for AIS shall be provided such AIS services if they are not enrolled in the RTI program.

For the 2013-2014 school year, the _____________________________________ (fill in)

School District will provide a Response to Intervention (RtI) program in the following buildings, grade levels and subject areas:

School Buildings Providing RtI Grade Level(s)* Subject Area(s) **

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(Please add additional rows as needed)

* Grade Level(s): (e.g., K-4 or grades 5, 6, and 8)

**Subject Area(s): (can indicate a skill area or a content area - e.g., reading for younger students or literacy skills as it applies to older students struggling in content, such as math or English)

|Printed/Typed Name of School Superintendent or Authorized Representative: |

|Name: Title: |

|Signature: |Date: |

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