Woodbridge School District

Instructional Support Team

Request for Assistance Form

To: Instructional Support Team

From:
Student: / DOB / Grade:

Please state your concerns regarding this student and your need for assistance to help this student be successful:

Prior interventions tried: (see back for some suggestions)

Date of last parent contact:

Is there anything else you would like the team to know at this time?

Please list days and times you would be available for someone from the team to meet with you to discuss this request with you.

* Return this request to the IST mailbox. A member of the team will contact you after your request has been received and reviewed at our weekly meeting. Thank you.


Here are some sample prior interventions. This list is by no means all inclusive….nor does it mean that you need to have tried them all. They are provided here as a jog to your memory.

1.  Spoke to student privately after class, explained expectations and how student fell short of expectations: stated desire change.

2.  Changed student’s seat.

3.  Spoke to Parent on telephone.

4.  Reviewed student’s cumulative folder.

5.  Held conference with parent in school or at home.

6.  Sent home daily/weekly behavior/school contracts.

7.  Assigned student lunch detention.

8.  Provided additional after school or before school help.

9.  Conferenced with former teachers to identify strategies that worked before and implemented strategies listed.

10.  Referred student to guidance counselor.

11.  Made a point to identify student’s interests and incorporated them into instruction.

12.  Chunked assessments.

13.  Provided additional time for assignments

14.  Provided additional time for assessments

15.  Provided graphic organizers

16.  Provided peer assistance in classroom

17.  Modeled expectations for student

18.  Provided supplemental materials

19.  Stood close to student during instruction

20.  Made frequent checks for partial completion of assignments

21.  Taught specific memory techniques

22.  Used varying modalities of instruction.

23.  Provided students with copy of instructional notes

24.  Broke up activities into small units.

25.  Taught specific methods of self-monitoring

26.  Rewarded appropriate behavior (catch student being good).

27.  Gave student frequent opportunities to get up and move around. Allow space for movement.

28.  Gave the student a responsible job

29.  Helped the student organize work.

30.  Taught reminder cues (a gentle touch on the shoulder, hand signal, etc.).

31.  Told the student your expectations of what paying attention looks like. (You look like you are paying attention when...)

32.  Had student repeat questions before answering.

33.  Using the wall clock, told student how long they are to work on an assignment.

34.  Alternated physical and mental activities.

35.  Increased the novelty of lessons by using films, tapes, flash cards, or small group work or by having a child call on others.

And many more….

#95