Section 4: Examples of Completed RTI Forms

1. Identify the Problem

HENRY HYPOTHETICAL 11-20-087-26-03 MALE ANY DISTRICT

ANY TEACHER K ANY SCHOOLHORTENSE HYPOTHETICAL ANY NUMBER

9-10-08O O 9-10-08 O0 0

OO

HENRY IS COOPERATIVE, WILLING TO WORK

HARD, IS NOT EASILY DISCOURAGED, AND GETS ALONG WELL WITH OTHERS

KINDERGARTEN – NOT APPLICABLE

NA NA NA NANA NA NA

xx

x

HOUGHTON MIFLIN

HENRY IS STRUGGLING TO LEARN LETTER NAMES, AND IS PROGRESSING

AT A RATE WELL BELOW THAT OF HIS PEERS.

SAXON MATH

SPEECH THERAPY CURRENTLY

x

x

x

x SENT PRACTICE WORKSHEETS HOME WITH NOTE TO PARENT

HORTENSE/9-15-08

(9-15, 9-22, 9-29, 10-6, 10-13, 10-20, 10-27)

DAILY FOR 5-10 MINUTES

MOVED TO FRONT ROW (ONCE)

HENRY HYPOTHETICAL 11-22-08ANY TEACHER K

HENRY IS

STRUGGLING TO LEARN LETTER NAMES

xx

2. Define the Problem in Measurable Terms

HENRYAIMSWEB LETTER NAMING FLUENCY

ZERO LETTERS PER MINUTE

14 LETTERS PER MINUTE

x

x

x

WORK RECORD

AIMSWEB BENCHMARK (LETTER NAMING FLUENCY)

3. Plan Intervention

6

O AIMSWEB KINGERGARTEN LETTER NAMING PROBE

HENRY NAME LETTERS

20 LETTERS PER MINUTE

HENRY WILL PRACTICE WITH LETTER FLASH CARDS

LETTER FLASH CARDS TITLE I READING TEACHER

11-23-08 TITLE I READING ROOM

15 MINUTES PER DAY/75 PER WEEK INTERVENTION LOG/REVIEW

4. Monitor Progress

LETTERS NAMED CORRECTLY TITLE I READING TEACHER

WEEKLY TITLE I READING TEACHER

JANUARY 25, 2009

HENRY WILL COMPLETE LETTER MAT ACTIVITY

LETTER MAT, DIE-CUT LETTERS TITLE I READING TEACHER

11-23-08 TITLE I READING ROOM

15 MINUTES PER DAY/75 PER WEEK INTERVENTION LOG/REVIEW

LETTERS NAMED CORRECTLY TITLE I READING TEACHER

TITLE I READING TEACHERWEEKLY

CLASSROOM TEACHER

SCHOOL PSYCHOLOGIST

TITLE I READING TEACHER

RTI COORDINATOR

SPEECH/LANGUAGE THERAPIST

5. Evaluate the Results

HENRY HYPOTHETICAL 1-25-09

ANY TEACHER K

OOO

O

xx

x

5. (continued) Modify the Plan

3-15-09

CLASSROOM TEACHER

SCHOOL PSYCHOLOGIST

TITLE I READING TEACHER

RTI COORDINATOR

SPEECH/LANGUAGE THERAPIST

1. Identify the Problem

HANNAH HYPOTHETICAL 1-24-0910-4-92 FEMALE ANY DISTRICT

ANY TEACHER TENTH ANY SCHOOLHORTENSE HYPOTHETICAL ANY NUMBER

1-14-08 O 1-14-08O6 4

FIRSTOO

HANNAH WANTS TO PLEASE, ATTENDANCE

IS ADEQUATE, PARENT IS CONCERNED

NA NA D CF F

(HISTORY) (P.E.)A

xxx

x

x

x

HANNAH IS A VERY SLOW READER, AND THIS HAS A NEGATIVEIMPACT ON READING COMPREHENSION. SHE ALSO STRUGGLESTO COMPLETE READING ASSIGNMENTS IN A TIMELY MANNER, AND HER GRADES REFLECT THIS.

PRENTICE HALL

NONE

SOCIAL WORK (DISTRICT SSW) GRADES 7-10 (RECEIVES CURRENTLY)

x

x

x

x

x

x

FOUR TIMES

SEVERAL TIMES PER WEEK

AFTER-SCHOOL TUTORING ONCE PER WEEK

MOVED CLOSER TO STRONG READERS TWICE

HORTENSE/1-20-08

HORTENCE/1-5-08

HANNAH HYPOTHETICAL 1-25-09ANY TEACHER TENTH

READING FLUENCY

x REPORT CARD, ACADEMIC RECORDS REVIEW

xx

2. Define the Problem in Measurable Terms

HANNAH’STHIRD GRADE

AIMSWEB R-CBM

62 WORDS READ CORRECTLY

134 WORDS READ CORRECTLY ON EIGHTH GRADE PASSAGE

Reading at 3rd grade level……

Monitor progress at 4th grade level…

AIMSWEB GROWTH TABLE FOR R-CBM

x

x AIMSWEB SURVEY LEVEL ASSESSMENT

3. Plan Intervention

6

O FOURTH GRADE R-CBM PROBE

HANNAH READ

80 WORDS READ CORRECTLY

DAILY USE OF “REWARDS” READING PROGRAM

“REWARDS” READING MATERIALS LANGUAGE ARTS TEACHER

1-28-09 LANGUAGE ARTS ROOM

40 MIN. PER DAY/200 PER WEEK INTERVENTION LOG/REVIEW

4. Monitor Progress

WORDS READ CORRECTLY PER MINUTE

WEEKLY

LANGUAGE ARTS TEACHER

LANGUAGE ARTS TEACHER

3-15-09

STUDENT

LANGUAGE ARTS TEACHERSCHOOL PSYCHOLOGIST

RTI COORDINATOR

5. Evaluate the Results

HANNAH HYPOTHETICAL 3-15-09

ANY TEACHER TENTH

OOO O

x

xx

x

x

5. (continued) Modify the Plan

HANNAHFOURTH GRADE

R-CBM PROBE

78 WORDS READ CORRECTLY

134 WORDS READ CORRECTLY ON EIGHTH GRADE PASSAGE

x

x AIMSWEB R-CBM PROGRESS MONITORING

6

O FOURTH GRADE R-CBM PROBE

HANNAH READ

120 WORDS READ CORRECTLY

DAILY USE OF “REWARDS” READING PROGRAM

“REWARDS” READING MATERIALS LANGUAGE ARTS TEACHER

LANGUAGE ARTS TEACHER

LANGUAGE ARTS TEACHER

LANGUAGE ARTS ROOM3-16-09

65 MIN. PER DAY/325 PER WEEK INTERVENTION LOG/REVIEW

WORDS READ CORRECTLY PER MINUTE

WEEKLY

5-2-09

STUDENT

LANGUAGE ARTS TEACHERSCHOOL PSYCHOLOGIST

RTI COORDINATOR

STEP 1: IDENTIFY THE PROBLEM

STEP 2: DEFINE THE PROBLEM IN MEASURABLE TERMS

STEP 3: PLAN THE INTERVENTION

STEP 4: MONITOR PROGRESS

STEP 5: EVALUATE THE PLAN

STEP 5: (CONTINUED) MODIFY THE PLAN