Texas Literacy Initiative Martha Medina, RTI Coordinator TLI Teacher Specialists: Patricia Cisneros Young Laura Martinez Roxanne Reyna Ninfa Garcia, Ph.D. Pace Cluster

New TLI will assist by providing intervention options for the TEACHER.

Parent Forms

BISD believes in providing Interventions to students who are not meeting standards BISD believes in effective education for Each Child, we utilize the 4 Tiered approach, RtI Based on cumulative data, your child has been referred for an intervention process, RtI

Questions to the parent regarding family, child behaviors, and/or Health concerns

The Parent acknowledges that the BISD has informed them of the RtI process and that the child will receive interventions.

RtI-1 Form Initial Student Referral to RtI Process

For major behavior concerns, refer to Review 360

Most information may be found in the student’s Personal Records Folder Academic and assessment data collection, select all that applies New

Select Accommodations that have been given the student If Very Effective, it may be an indicator that the student can perform better and that he/she may not have a learning problem

RtI-2 Form Student Health Information

Nurse will fill this form out for the student.

RtI-3A Form Screening for Language Dominance

Teachers should keep in mind that language may be a barrier affecting student’s academic performance. This is for all students.

RtI-3B Form Student Language Observation

Each teacher of the referred student needs to complete this check list Only filled out for Bilingual students.

RtI-4 Form Minutes and Action Log

RtI Coordinator will complete this form to make sure all paperwork has been filled out.

Collection of Student Data Achievement Scores ex. STAAR/ TELPAS/ STANFORD/ and etc… Grades ex. Current Grades Speed/ TPRI/ TEJAS LEE/TMSFA Input from Parents ex. Parent Information Form Attendance reports ex. Report from Data Entry

RtI-5 Individual Intervention Plan Elementary

New

RtI-5 Individual Intervention Plan Middle School

RtI-5 Individual Intervention Plan High School

You can provide any of these accommodat- ions for students. Only if they have an X under RtI Team.

RtI-6 Signature Form

Acknowledging that we have an instructional plan in place with adequate interventions for the child. And that it will be implemented with fidelity. New Observation needs to be documented for 18 weeks.

RtI-7 Progress Monitoring Record

RtI-14A Form Speech Language Dominance

Each teacher of the referred student needs to complete this check list

RtI-14B Form Student Oral Language Observation

Each teacher of the referred student needs to complete this check list

RtI-14C Form Speech Parent Interview

Parent Interview focuses on Birth Medical History and Developmental Background.

Additional Documentation Forms for Speech

RtI-10 Form Behavioral

RtI-11 Form Behavioral

RtI-12 Form Behavioral

RtI-13 Form Behavioral

RtI-9A Form Dyslexia

RtI-9B Form Dyslexia

RtI-14 Consent to Release Confidential Information

RtI-8A Form 504

RtI-15 Form Referral for Consideration of Special Education

Texas Literacy Initiative Martha Medina, RtI Coordinator Teacher Specialists: Patricia Cisneros Young Laura MaRtInez,and Roxanne Reyna Pace Cluster