RTI Folder.pub - Anderson County School District 4

Response to Intervention (RTI)
Students who are having difficulties in
school can be referred to the school’s
Response to Intervention team by parents,
teachers, and other school personnel
for further intervention and assistance.
The RTI process has three
phases which are outlined in this
folder. The forms are enclosed and can
be found on the intranet under Curriculum
and Instruction.
Interventionist: ____________________________________________
Intervention Guidelines
The purpose of the intervention team is collaboratively problem
solve to develop an intervention for the specific student.
The intervention may have ancillary benefits for others, including
the teacher or other students; however, the intervention’s
focus is the individual student who has been referred.
The intervention should be based upon scientifically based
research methods and/or peer-reviewed methods that are
known to be effective when applied.
An intervention is a current action that differs from the activities that normally occur in the student’s
general education program. It is a written plan based on an individual student problem, which includes
the following basic components:
1. A clear statement of the problem;
2. A problem analysis that uses data to confirm the initial concern;
3. Development of a specific research-based intervention based on the problem analysis; and
4. Baseline data.
Progress Monitoring Data
RTI Forms
RTI 1 - 1 Teacher Concerns Sheet
RTI 1 - 2 Initial Referral Sheet
RTI 1 - 3 School History
Parent Invitation to Attend RTI meeting
RTI 1 - 4 Parent Concerns Sheet (2 pgs)
RTI 1 - 5 Student Intervention Plan (Folder p. 2)
Minutes of RTI
RTI 2 - 6 Parent Permission for Screening
RTI 2 - 7 Vision, Hearing & Speech/Lang. Screening
Date Intervention Freq/Duration Progress Monitoring
Tool
Target Area _______________
Results/Observations
Name _________________________________ Grade _________ Teacher ____________________School ________________ School Year ________

RTI PHASE ONE
When a student in your class is having difficulties. . .
A. Teacher completes the following steps: B. Teacher contacts parent and administrator/designee to
Date:
set up initial meeting for Phase One to discuss concerns.
(Parent Invitation)
Teacher completes Concerns Sheet (RTI1-1).
C. Have parent complete Parent Concerns Sheet (RTI 1-
Teacher completes Forms (RTI1-2).
4). This could be sent home, completed via telephone,
or completed at the meeting/
Teachers checks with previous teachers, if applicable.
Teacher reviews cumulative folder and completes
school history (RTI 1-3).
Teacher inserts work samples and other documentation
to Phase One Forms.
D. Teacher, administrator and parent review all forms and
develop Student Intervention Plan at the meeting.
Also, complete Minutes of RTI Meeting.
E. Teacher implements student intervention plan for a
minimum of fifteen (15) school days.
STUDENT INTERVENTION PLAN

If the student continues to have difficulties. . . . .
RTI Phase Two
Date: Teacher contacts student Intervention Team Chairperson (ITC) with request for Phase 2.
ITC coordinates a meeting with parent and required participants-referring sources, administrator/designee, at
least one school intervention team member and guidance counselor. (Invitation)
Review Student Intervention Plan. Bring copies of DIBELS, Grades, MAP Scores, and Anecdotal records, discipline
reports. Complete Minutes of RTI. (Minutes of RTI)
Decide what we are going to do for the student:
DATE: RECOMMENDATION NOTES
Attendees
Signatures
Principal:
Continue with current intervention.
Change frequency or duration of intervention to:
Teacher:
Parent:
Try new intervention:
Other(s):
Change to Phase ___________
Goals reached. Discontinue interventions.
Date of next meeting _______________
RTI Phase Two
If the team decides to continue with intervention and the student continues to have difficulties. . . . .
Date: Teacher contacts student Intervention Team Chairperson (ITC) with request for another evaluation of Phase 2..
ITC coordinates a meeting with parent and required participants-referring sources, administrator/designee, at
least one school intervention team member and guidance counselor. (Invitation)
Review Student Intervention Plan. Bring copies of DIBELS, Grades, MAP Scores, and Anecdotal records, discipline
reports. Complete Minutes of RTI. (Minutes of RTI)
Decide what to do for the student. See next table on back.

Attendees
Signatures
Principal:
DATE: RECOMMENDATION NOTES
Continue with current intervention.
Change frequency or duration of intervention to:
Teacher:
Parent:
Try new intervention:
Other(s):
Change to Phase ___________
Goals reached. Discontinue interventions.
Date of next meeting _______________
RTI PHASE THREE
Participants-parent, referring source, school
intervention team, and administration.
Review all screening and data documentation.
Decide if further formal evaluation is needed ;
OR Continue with present intervention plan ;
OR Develop 504 plan.
Record all information on Minutes of RTI
form.
If the intervention team deems it appropriate, a referral and
all supporting documentation (RTI Forms) should be sent
to the school referral coordinator. Parents are provided a
copy of the Listing of Parental Rights for Special Education.
The following forms are completed and forwarded to
the Special Services Office:
Permission for Evaluation
Notification of Referral and Evaluation
Health and Development History
Consent for Treatment
Release of Information
Evaluations are scheduled and completed within 60 calendar days.
Staffings to be scheduled by the Special Services Office are held in order to determine if a student is eligible
for special education and related services.
At a minimum, the following District personnel must be in attendance at the initial staffing:
Principal or designee
Referring teacher
Person knowledgeable about special education or related services
District Office representative
Parent (must be given an opportunity to participate)