Individual Reading Plan Checklist for K-3 Students Receiving Tier 3 ...
IRP-1
MTSS IRP 2016
Individual Reading Plan Checklist for K-3 Students Receiving Tier 3 Interventions
Student Name:
Teacher/School:
Date:
Following the identification of a reading deficiency, intensive reading instruction and intervention must be documented for each student in an Individual Reading Plan (IRP), which includes the following:
Place a when
completed
________ ________ ________ ________
________
________
________
Description
Evidence
(a) The student's specific, diagnosed reading skill deficiencies as determined (or identified) by diagnostic assessment data;
(b) The goals and benchmarks for growth;
(c) How progress will be monitored and evaluated;
(d) The type of additional instructional services and interventions the student will receive;
(e) The research-based reading instructional programming the teacher will use to provide reading instruction, addressing the areas of phonemic awareness, phonics, fluency, vocabulary, and comprehension;
(f) The strategies the student's parent is encouraged to use in assisting the student to achieve reading competency; and,
(g) Any additional services the teacher deems available and appropriate to accelerate the student's reading skill development
Attach the following applicable reports to the TST-2: Student Data Sheet:
? STAR Diagnostic Report ? STAR Instructional Planning Report ? i-Ready Student Profile Report ? MKAS K Diagnostic Report ? MKAS K Instructional Planning Report ? MAP Score Report ? Good Cause Exemption Documentation
TST-7: Tier Worksheet
TST-7: Tier Worksheet
TST-7: Tier Worksheet
IRP Instructional Program/ Additional Services Form
GSD Parent Read-at-Home Plan (Attach the items below) ? MKAS K Instructional Planning Report ? STAR Instructional Planning Report ? i-Ready Parent Report ? Parent Notification Letter ? GSD IRP Parental Receipt Form
IRP Instructional Program/ Additional Services Form
NOTE: The Individual Reading Plan (IRP) is required for students in grades K-3 who, at any time, exhibit a substantial deficiency in reading, as well as students who were promoted to 4th grade with a good cause
exemption.
IRP-2
MTSS TST-2 Revised 8/2016
TST-2: STUDENT DATA SHEET Gulfport School District
Student: __________________________ School: _____________ Grade: _____ Teacher: ____________________
Date of Birth: ____________________ Parent: _______________________________ Phone: _________________
A. REASON FOR REFERRAL
Academic Areas Mathematics Reading Other: ___________________________________
Social, Emotional, and/or Behavioral concerns Complete SBE Checklist (TST-3)
This student is currently receiving services for language/speech.
MEDICATION
This student is currently taking prescription medication.
Name of medication(s): ___________________________________________________
B. CUMULATIVE RECORD REVIEW -Each area must be addressed-OR-indicate as not applicable (NA)
ATTENDANCE (Current, Preceding School Years)
School Year
Days Present / Days Absent
__________
___________ /___________
__________
___________ / ___________
__________
___________ / ___________
List last 3 schools attended and dates.
____________________________ / ____________
____________________________ / ____________
____________________________ / ____________
RETENTION
Grade __________
School Year ___________
__________
___________
__________
___________
AVAILABLE DISCIPLINE RECORD Number of discipline reports_______ Number of suspensions ___________
In-school ____________________ Out-of-school_________________
RECENT ACADEMIC GRADES
1. English/Language Arts_________ 2. Reading ____________________ 3. Math _______________________ 4. Science _____________________ 5. Social Studies ________________ 6.Algebra I_____________________ 7.English II____________________ 8. Biology_____________________ 9. US History___________________
C. ASSESSMENT DATA/SPECIAL POPULATION -Each area must be addressed-OR-indicate as not applicable (NA)
LITERACY BASED PROMOTION ACT MKAS 3rd GRADE
Attempts Date Score Pass/Fail
1st Attempt
UNIVERSAL SCREENERS
School Year: ________________________
Reading i-Ready
Placement Level
Fall
Winter
Spring
Math i-Ready
Placement Level
SPECIAL POPULATION Check if applicable.
o Special Education/ IEP Eligibility Category _____________ ______________________________
o 504
1st Retest
2nd Retest
MKAS READINESS
SS:
KINDERGARTEN Date:
DYSLEXIA SCREENER (Pass/Fail)
K:
1st:
Fall Winter Spring
_________________________________________________
Indicate Risk Level: Red, Yellow, or Green Behavior BESS-T BESS-S SSIS-P SSIS-M
Fall
o ELL o Dyslexia o Other_________________________
D. TEACHER OBSERVATIONS-Place a check in all applicable boxes.
PHYSICAL & COMMUNICATION
PARTICIPATION
Generally appears healthy
Attends school regularly/Arrives on time for class
Normal energy level
Completes assignments/Follows directions
Gross/Fine motor coordination is age-appropriate Speech (articulation) is age-appropriate
Concentrates and able to attend to instruction Participates in class
Spoken/Written language is age-appropriate
Functions independently
SOCIAL
RELATED CONCERNS
Age appropriate self-help skills
Exhibits behaviors appropriate for age/school setting
Displays feelings appropriate to situation
Appropriate peer contacts
Relates well to adults/peers
Appropriate personal hygiene
Mark One: ______ Yes _______ No This student is in grades K-3 and has been identified with a substantial reading deficiency as indicated by the data attached.
NOTE: A substantial reading deficiency may be defined by a score in the "Urgent Intervention" category as set by Renaissance Learning, a score of 2 or more grade levels below on the i-Ready Diagnostic Assessment, a score of Level 1 on the 3rd grade statewide end-of-year
assessment (MAP), or 3rd graders promoted to 4th grade due to a Good Cause Exemption.
IRP-3
MTSS TST-7 Revised 8/2016
TST-7: TIER WORKSHEET
Student: _______________________________________________________ School: _________________________School Year: _________________ Grade: _________ Parents Notified: ______Yes ______No
Annual Goals (Check applicable goal statements.) 1. Student will meet annual growth to be on track in i-Ready Reading with a scale score increase of __________ by 5/24/17. 2. Student will meet annual growth to be on track in i-Ready Math with a scale score increase of __________ by 5/24/17. 3. Student will meet an annual goal of __________ SS with an expected growth rate of __________ SS/week on STAR Reading. 4. Student will meet an annual goal of __________ SS with an expected growth rate of __________ SS/week on STAR Early Literacy. 5. Student will achieve _______Correct Writing Sequences with _______ Total Words Written on grade _______ writing samples. 6. Behavior: _____________________________________________________________________________________________________________________________. 7. Behavior: _____________________________________________________________________________________________________________________________. 8. Behavior: _____________________________________________________________________________________________________________________________.
Specify Tier Tier 2____Tier 3____ Tier 2____Tier 3____
Tier 3____ Tier 3____ Tier 2____Tier 3____ Tier 2____Tier 3____ Tier 2____Tier 3____ Tier 2____Tier 3____
Was goal met? Yes, No, or N/A Tier 2 Goal______ Tier 3 Goal______ Tier 2 Goal______ Tier 3 Goal______
Tier 3 Goal______ Tier 3 Goal______ Tier 2 Goal______ Tier 3 Goal______ Tier 2 Goal______ Tier 3 Goal______ Tier 2 Goal______ Tier 3 Goal______ Tier 2 Goal______ Tier 3 Goal______
Tier 2 Start Date: _________________________Tier 2 Observation Date: _________________________ Tier 2 Meeting Dates: _____________________, _____________________, _____________________
Describe supplemental and/or small group programming/strategies utilized (should be evidence-based and include frequency, duration):
Name(s) and role(s) of individual(s) responsible for delivering intervention:
Frequency of Progress Monitoring: Academic- i-Ready Growth Monitoring/Standards Mastery 1 x/month. Behavior- Review 360 daily tracking.
Tier 3 Start Date: __________________________ Tier 3 Observation Dates: _________________________ _________________________ Intervention meets fidelity requirements (See TST-8). Instructions: TST members should complete this section for students that did not respond to tier 2 interventions, for K-3 students identified with a substantial reading deficiency, for 4th grade
students requiring intensive intervention after a Good Cause Exemption promotion, OR for intensive reading interventions for special education students (K-4) and English Language Learners.
Describe intensive intervention programming/strategies being utilized (should be evidence-based and include frequency, duration):
Name(s) and role(s) of individual(s) responsible for delivering intervention:
Frequency of Progress Monitoring: Academic- i-Ready Growth Monitoring/Standards Mastery 1 x/month. STAR 1 x/month. Behavior- Review 360 daily tracking.
First Intervention Review Date (6 weeks) ___________________________________________________ Successful Interventions? _______________Yes _______________No Second Intervention Review Date (12 weeks) ________________________________________________ Successful Interventions? _______________Yes _______________No
Signature/Position
Signature/Position
Signature/Position
IRP-4
MTSS IRP 2016
Literacy-Based Promotion Act Gulfport School District Individual Reading Plan (IRP)
Instructional Program/Additional Services Form
Student Name:
School:
Date:
What research-based program(s) will be used to deliver explicit, systematic core reading instruction during the required 90-minute reading block?
Indicate the areas addressed by the core reading program:
Phonemic Awareness Phonics Fluency Vocabulary Comprehension
Additional supplemental materials (if applicable):
Indicate any additional services the teacher deems available and appropriate to accelerate the student's reading skill development, if applicable:
IRP-5
MTSS IRP 2016
Gulfport School District Individual Reading Plan (IRP) Parental Receipt Form
Written Parental Notification that my child has been identified with a substantial deficit in reading has been received.
Parent Initial: ____________________
Date: ____________________
I acknowledge I have received a copy of a GSD Parent Read-at-Home Plan. My questions regarding this plan have been addressed.
Parent Initial: ____________________
Date: ____________________
................
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