1. Section 4: Examples of Completed RTI Forms

2. 1. Identify the Problem HENRY HYPOTHETICAL 11-20-08 7-26-03MALEANY DISTRICT ANY TEACHERKANY SCHOOL HORTENSE HYPOTHETICALANY NUMBER 9-10-08 O O O 00 O O HENRY IS COOPERATIVE, WILLING TO WORK HARD, IS NOT EASILY DISCOURAGED, AND GETS ALONG WELL WITH OTHERS

3. KINDERGARTEN – NOT APPLICABLE NA x x x

4. HOUGHTON MIFLIN HENRY IS STRUGGLING TO LEARN LETTER NAMES, AND IS PROGRESSING AT A RATE WELL BELOW THAT OF HIS PEERS. SAXON MATH SPEECH THERAPYCURRENTLY

5. 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)

6. HENRY HYPOTHETICAL11-22-08 ANY TEACHERK HENRY IS STRUGGLING TO LEARN LETTER NAMES x x

7. 2. Define the Problem in Measurable Terms HENRY AIMSWEB LETTER NAMING FLUENCY ZERO LETTERS PER MINUTE 14 LETTERS PER MINUTE

8. x x x WORK RECORD AIMSWEB BENCHMARK (LETTER NAMING FLUENCY)

9. 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 CARDSTITLE I READING TEACHER 11-23-08 TITLE I READING ROOM 15 MINUTES PER DAY/75 PER WEEKINTERVENTION LOG/REVIEW

11. 4. Monitor Progress LETTERS NAMED CORRECTLYTITLE I READING TEACHER WEEKLYTITLE I READING TEACHER

12. 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 WEEKINTERVENTION LOG/REVIEW LETTERS NAMED CORRECTLYTITLE I READING TEACHER WEEKLY

13. CLASSROOM TEACHER SCHOOL PSYCHOLOGIST TITLE I READING TEACHER RTI COORDINATOR SPEECH/LANGUAGE THERAPIST

14. 5. Evaluate the Results HENRY HYPOTHETICAL1-25-09 ANY TEACHERK O O O O

15. x x

16. x

17. 5. (continued) Modify the Plan

21. 3-15-09

22. CLASSROOM TEACHER SCHOOL PSYCHOLOGIST TITLE I READING TEACHER RTI COORDINATOR SPEECH/LANGUAGE THERAPIST

23. 1. Identify the Problem HANNAH HYPOTHETICAL1-24-09 10-4-92 FEMALEANY DISTRICT ANY TEACHER TENTH ANY SCHOOL HORTENSE HYPOTHETICALANY NUMBER 1-14-08 O O 6 4 FIRST O O HANNAH WANTS TO PLEASE, ATTENDANCE IS ADEQUATE, PARENT IS CONCERNED

24. NA D C F F (HISTORY)(P.E.) A x x x x x x

25. HANNAH IS A VERY SLOW READER, AND THIS HAS A NEGATIVE IMPACT ON READING COMPREHENSION. SHE ALSO STRUGGLES TO COMPLETE READING ASSIGNMENTS IN A TIMELY MANNER, AND HER GRADES REFLECT THIS. PRENTICE HALL NONE SOCIAL WORK (DISTRICT SSW)GRADES 7-10 (RECEIVES CURRENTLY)

26. 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

27. HANNAH HYPOTHETICAL1-25-09 ANY TEACHER TENTH READING FLUENCY x REPORT CARD, ACADEMIC RECORDS REVIEW x x

28. 2. Define the Problem in Measurable Terms HANNAH’S THIRD GRADE AIMSWEB R-CBM 62 WORDS READ CORRECTLY 134 WORDS READ CORRECTLY ON EIGHTH GRADE PASSAGE

29. Reading at 3 rd grade level…… Monitor progress at 4 th grade level…

30. AIMSWEB GROWTH TABLE FOR R-CBM

31. x x AIMSWEB SURVEY LEVEL ASSESSMENT

32. 3. Plan Intervention 6 O FOURTH GRADE R-CBM PROBE HANNAH READ 80 WORDS READ CORRECTLY DAILY USE OF “REWARDS” READING PROGRAM “REWARDS” READING MATERIALSLANGUAGE ARTS TEACHER 1-28-09 LANGUAGE ARTS ROOM 40 MIN. PER DAY/200 PER WEEK INTERVENTION LOG/REVIEW

33. 4. Monitor Progress WORDS READ CORRECTLY PER MINUTE WEEKLY LANGUAGE ARTS TEACHER

34. 3-15-09

35. STUDENT LANGUAGE ARTS TEACHER SCHOOL PSYCHOLOGIST RTI COORDINATOR

36. 5. Evaluate the Results HANNAH HYPOTHETICAL 3-15-09 ANY TEACHERTENTH O O O O

37. x x x x

38. x

39. 5. (continued) Modify the Plan HANNAH FOURTH GRADE R-CBM PROBE 78 WORDS READ CORRECTLY 134 WORDS READ CORRECTLY ON EIGHTH GRADE PASSAGE

40. x x AIMSWEB R-CBM PROGRESS MONITORING

41. 6 O FOURTH GRADE R-CBM PROBE HANNAHREAD 120 WORDS READ CORRECTLY

42. DAILY USE OF “REWARDS” READING PROGRAM “REWARDS” READING MATERIALSLANGUAGE ARTS TEACHER LANGUAGE ARTS ROOM 3-16-09 65 MIN. PER DAY/325 PER WEEK INTERVENTION LOG/REVIEW WORDS READ CORRECTLY PER MINUTE WEEKLY

43. 5-2-09

44. STUDENT LANGUAGE ARTS TEACHER SCHOOL PSYCHOLOGIST RTI COORDINATOR

45. STEP 1: IDENTIFY THE PROBLEM

50. STEP 2: DEFINE THE PROBLEM IN MEASURABLE TERMS

53. STEP 3: PLAN THE INTERVENTION

54. STEP 4: MONITOR PROGRESS

56. STEP 5: EVALUATE THE PLAN

60. STEP 5: (CONTINUED) MODIFY THE PLAN