Student Name ________________________ Teacher Name _____________________
Date of Submission ______________________
Tier 1 Classroom Behavior Management Summary:
Academic differentiation that optimizes engagement
Clear Classroom Behavior Management Plan, with solid student-teacher relationships, positive reinforcement, and clear consequences Expectations are taught and understood (whole class) Redirect Reteach Take a break (Reflection Form) Buddy Room (Reflection Form) Zones of Regulation Accommodations (preferential seating, modified work) Other (i.e PBISWorld, Smartclassroommanagement.com)
Behavior: Example: Work Skills - Following Directions - Social & Emotional Support
Differentiation: Results for (Student):List data collected (frequency,
time of day, patterns, duration) and summarize the effect of this differentiation (include artifacts)
Tier 1 Academic Summary:
English/Language Arts
Differentiation: Results for (Student):
Through Daily 5 Goal setting & 1:1 conferring,
is working at the level that is appropriate
Sight Word Work: Has sight word flashcards for
reinforcement of basic words
Leveled Guided Reading/Strategy Groups
(below level materials) reinforcement of vocabulary, comprehension strategies/skills Tier I Differentiation and Accommodations (Grade level team and school supports)
Student Name ________________________ Teacher Name _____________________
Date of Submission ______________________
Math
Differentiation: Results for (Student):
Math In Focus Curriculum with 1:1 support
from adults in the room
Xtramath.org for Fact Fluency
Use of manipulatives to complete math work
Math assessment materials are read aloud and
guided by teacher (entire class)
General Accommodations for (Student):
Tier 2 Progress Monitoring
Intervention: Progress Monitoring Data: Results:
Reading Corps - Repeated Reading with Comprehension Strategy
Regular small group intervention
(flexible groups) - Reinforcement and re-teaching of comprehension skills/strategies; -Teaching comprehension skills at the appropriate reading level