Dardanelle School District
Response to Intervention
This process begins when a teacher and/or parent determines that a specific child is struggling in the educational setting. It may be academic, behavioral or social in nature. The following procedures are established to assist the staff in a timely manner with their concerns.
Please complete the following steps prior to first meeting:
- Arrange for vision/hearing screening with the school nurse (page 2 attached). Results are considered current if they are within one (1) calendar year.
- Notify parent/guardian with your concerns (parent notification form page 3 attached).
- Refer to student’s cumulative folder to obtain information to complete the student study beginning on page 4 of this packet.
- Attach work samples, current grades, discipline referrals, and any other pertinent data.
- Turn complete packet into RTI chairperson.
Your completion of these forms will provide the RTI team will valuable information necessary to better help your student be successful.
Dardanelle School District
HEARING and VISION RESULTS
HEARING SCREENING
1st Screening Date:
Results:
2nd Screening Date:
Results:
VISION SCREENING
1st Screening Date:
Results:
2nd Screening Date:
Results:
Known medical information (past and current):
Current medications:
Parent Notification of Response to Intervention Process
Date:
To the parents/guardians of:
Your child has demonstrated academic difficulties in the regular classroom and is in need of additional educational assistance to improve one or more of the following skills:
☐Reading
☐Math
☐Behavior
☐Other
The district will begin collecting educational performance data to include current work samples, grades, assessment scores, educational history, classroom observations and other relative information. The data will be used by the RTI (Response to Intervention) team along with the classroom teacher to develop appropriate interventions to aid your child in improving academically. All information shared with the team is confidential.
We will keep you informed of your child’s progress quarterly. Please feel free to contact us at your child’s school if you have any questions or concerns. Thank you for your support in helping your child succeed in school.
Sincerely,
Terry McElligott, RTI Chairperson
Dardanelle Intermediate School
479-229-3707
Debbie Murphy, RTI Chairperson
Dardanelle Primary School
479-229-4185
Student Study Packet Information
DateReferring Teacher
Student Name Date of Birth
Current Grade
Attendance Start Date Absences
Language of Student☐English☐Spanish ☐Other
Retained ☐Yes ☐No Grade Retained
Current Service: Check all that apply
☐ELL ☐Migrant ☐504 Plan ☐Speech/Language
☐Behavior Plan ☐AIP ☐Counseling ☐OT / PT
Parent / Guardian Name
Address
Phone (H)
(W)
(C)
Language of Parent ☐English☐Spanish ☐Other
Student Study
List student strengths (academic / behavior / social skills)
TEST DATA
DRA
Date: Results:
STAR READING
Date:Results:
DIBELS (DORF)
Date:Results:
MAZE
Date:Results:
MOBY MAX MATH
Date:Results:
DSA or PSI
Date:Results:
Check possible non-academic reasons for academic / behavioral difficulties, if known:
☐Frequent moves ☐Illness
☐Divorce / Separation ☐New person in home
☐Sibling rivalry ☐Lack of social skills
☐Custody suit ☐Death of family/friend
☐Other
Area(s) of Concern (mark all that apply)
READING ☐Basic Skills ☐Comprehension ☐Fluency
MATH ☐Basic Facts ☐Computation ☐Problem Solving
WRITTEN EXPRESSION ☐Mechanics ☐Content
STUDY SKILLS ☐Organization ☐Failure to complete assignments
SOCIAL SKILLS ☐Peers ☐Adults
LANGUAGE ☐Articulation ☐Expressive☐Receptive
Language Function
☐Has difficulty understanding directions, questions, commands
☐Unable to verbally express thoughts and feelings
☐Has difficulty formulating sentences
☐Has poor listening skills
☐Demonstrates articulation, fluency or voice difficulty
☐Frequently asks for instructions to be repeated
Social – Emotional Status
☐Has inadequate self-concept
☐Has difficulty with peers
☐Becomes easily upset over minor issues
☐Does not adapt well to change in routine
☐Easily discouraged
☐Has been considered for alternative education placement
Behavior
☐Frequently challenges authority
☐Always moving (feet, playing with materials, etc.)
☐Unable to stay in seat even for short periods of time
☐Acts before thinking
☐Displays short attention span
☐Is easily distracted
☐Is hypoactive (slow moving, slow to respond, talks slow, moves slow)
*Please check the behaviors impacting academic performance.*
READING☐Does not comprehend what is read
☐Does not finish assignments due to readingdifficulty
☐Does not use word attack skills
☐Omits, adds, substitutes, or reverses letters,words, Or sounds when reading / WRITING
☐Unable to copy letters, words, sentences, and numbers from a model
☐Reverses letters and Numbers
☐Does not Compose complete sentences or expresscomplete thoughts in writing
☐Does not organize writing activities
☐Unable to copy simple designs
MATHEMATICAL CALCULATIONS/CONCEPTS
☐Does not understand abstract concepts
☐Fails to correctly solve (+/-*) problems
☐Does not know/remember facts
☐Has difficulty solving math word problems / SPELLING
☐Has difficulty with phonetic approaches
☐Omits, substitutes, adds, or rearranges letters or
sounds when spelling
☐Requires continued drill and practice to learn
Spelling words
SPEAKING
☐Had difficulty imitating speech sounds
☐Distorts or mispronounces sounds/words
☐Not fluent when speaking
☐Does not complete thoughts when speaking
☐Has a limited speaking vocabulary / LISTENING
☐Does not follow verbal directions
☐Has difficulty differentiating speech sounds heard
☐Requires eye contact in order to listen
successfully
MEMORY/ORGANIZATION
☐Disorganized
☐Limited memory skills VISUAL/AUDITORY
☐Requires slow, sequential, presentation of
directions/concepts
☐Inconsistent learning behaviors / ATTENTION
☐Has difficulty staying on task
☐Doesn’t complete task before moving on to
another
☐Begins work impulsively without direction
☐Easily distracted
INTERPERSONAL RELATIONSHIPS
☐Has little or no interaction with teachers
☐Has little or no interaction with peers
☐Bothers other students
☐Cannot work appropriately in small groups
☐Touches other inappropriately in small groups
☐Appears to always be the victim / MOTIVATION/EMOTIONS
☐Avoids situations, assignments, and responsibilities
☐Ignores consequences of behavior
☐Does not appear to care about academic
performances
☐Easily agitated/hostile
☐Does not take responsibility for actions
Additional information:
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Dardanelle Public Schools
Progress Report
Student: Grade:Teacher:
In order to obtain an up-to-date account of how this student is doing academically and socially, we would like your comments and observations regarding his/her performance in your class.
Attention: ______
Participation: ______
General Classroom Behavior:______
Wearing visual aids: ☐Yes ☐No ☐N/A
Wearing hearing aids: ☐Yes ☐No ☐N/A
Working up to ability: ☐Yes ☐No
Classroom assignments complete: ☐Yes ☐No
Homework assignments complete: ☐Yes ☐No
Grade averages for current grading period:
Reading/Writing ______Spelling______Math______Science______Social Studies______
Comments/Questions about area(s) where student is struggling:
Please attach any work, data samples, intervention logs, etc. to aid the committee in making decisions. Decisions may not be made during meeting if ample data is not provided.
Thank you for your help and cooperation!
Dardanelle Intermediate RTI Committee