Individual Reading Plan Checklist for K-3 Students ...

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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