Wisconsin Rti Center2016 Recognized School Academic (Rti) Application

Wisconsin RtI Center2016 Recognized School Academic (RtI) Application

Applications are open from March 1, 2016 - April 27, 2016 @ 5:00pm

Tips for Success:

• Complete as much of the application as you can - you do not need to have all sections of the application well established to receive recognition but providing more detailed information will substantially improve scores.
• Do not include student or staff level identifiable data.
• Gather information/data needed to complete the application first - Look at the Word version of the application to determine what needs to be gathered AND complete the Word version first and then copy and paste the information into the electronic survey. DO NOT USE THE BROWSER BACK BUTTON AS YOUR DATA WILL BE LOST

Contact Melissa Marks at or (920) 948-5979 with any technical problems at least 72 hours before the application deadline. Questions or clarifications on specific questions in the application: Please contact your Wisconsin RtI Center Regional Technical Assistance Coordinator.

To apply schools must meet the following criteria:

Please confirm that you have met these criteria before completing the application.

For additional information about the Wisconsin RtI Center Recognized Schools criteria and printable applications, please visit the Wisconsin RtI Center website.

Yes / No
Must have a school implementation team with at least 3 team members as well as school decision maker. (Definition of decision maker - Principal, Assistant Principal, Dean of Students, Director of Learning, RtI/PBIS Coordinator, Pupil Services Director, Special Ed Director, Superintendent, Assistant Superintendent, Curriculum and Instruction Director.) /  / 
Must have a school implementation team that met at least 6 times over the past year. /  / 
Must have had the school decision maker (as defined above) attend at least 6 school implementation team meetings over the past year. /  / 
Must have a school team that has attended the Wisconsin RtI Framework Training (formally called the Foundational Overview Training). /  / 
Must have scored at full implementation (80-100%) on the School-wide Implementation Review (SIR) in the past 12 months (May 2015 to current) in the content area you are applying (score must be evidenced in the Wisconsin RtI Center SIR Database before you submit your application). /  / 
Must include at least 1 year of screening data. /  / 

Section 1: School Information

In which region is your school located? (If you are unsure which region, check this website:

DPI School Districts by CESA)

1. East Region (CESA 6 and 7)
2. North Region (CESA 8, 9 and 12)
3. South Region (CESA 2, 3 and 5)
4. Southeast Region (CESA 1)
5. West Region (CESA 4, 10 and 11)

From which district and school are you applying?

Section 2: Contact Information

Primary Contact Information

Note: The primary contact person will receive a PDF of the application via email after submission. If you do not receive the PDF, please contact Melissa Marks, f you would like to verify your submission.

First Name

Last Name

Phone

Email Address

Superintendent Contact Information

Salutation

1. Mr.
2. Mrs.
3. Ms.
4. Dr.
5. Other

First Name

Last Name

Address 1

Address 2

City

State

Zip

Email Address

Principal Contact Information

Salutation:

1. Mr.
2. Mrs.
3. Ms.
4. Dr.
5. Other

First Name

Last Name

Address 1

Address 2

City

State

Zip

Email Address

Coach/Coordinator Contact Information - Please indicate NA in the boxes you need to leave blank.

First Name / Last Name / Email
RtI Coordinator
District RtI Coordinator

What focus area are you applying for recognition?
(If you are applying for both Mathematics and Reading, you will need to complete two separate applications.)

 Mathematics

 Reading

Section 3: Implementation Team Information

Please enter the name and position title of your implementation team members including your decision maker:

(Definition of decision maker - Principal, Assistant Principal, Dean of Students, Director of Learning, RtI/PBIS Coordinator, Pupil Services Director, Special Ed Director, Superintendent, Assistant Superintendent, Curriculum and Instruction Director.)

We require at least 3 members as well as a decision maker to qualify for recognition. Please indicate NA in the boxes you need to leave blank.

Name / Position Title
Decision Maker
Team Member
Team Member
Team Member
Team Member
Team Member
Team Member
Team Member
Team Member
Team Member

Please enter the dates of your implementation team meetings, and whether a decision maker attended each meeting (from May 1, 2015 through present). Please indicate NA in the boxes you need to leave blank. *Schools must have at least 6 monthly meetings with a decision maker attending to qualify for recognition.

(Definition of decision maker - Principal, Assistant Principal, Dean of Students, Director of Learning, RtI/PBIS Coordinator, Pupil Services Director, Special Ed Director, Superintendent, Assistant Superintendent, Curriculum and Instruction Director)

Date of Monthly Meeting (MM/DD) / Did a decision maker attend this meeting? Please enter Yes or No
May 2015
June 2015
July 2015
August 2015
September 2015
October 2015
November 2015
December 2015
January 2016
February 2016
March 2016
April 2016

Section 4: Training/Assessment

What is the date that your school team last attended the Wisconsin RtI Center Framework training?

If you do not know the exact day of the training your team attended, please select the 1st of the month and year your team had attended the training.

Section 5: Implementation Self-Assessment

*Self-assessment scores at full implementation (80-100%) for this year (May 2015 or later) are required to receive recognition at the Merit level.

**At least two consecutive years (May 2014 through present) at full implementation are required to receive recognition at the Distinction level.

Mathematics or Reading: School wide Implementation Review (SIR) scores will be reviewed through the Wisconsin RtI Center's SIR database. Be sure that your SIR completion information is accurate and up-to-date in the Wisconsin RtI Center database prior to submitting your application(s). Please read and check the box below:

 I have verified that our Mathematics or Reading SIR is updated and accurate on the Wisconsin RtI Center’s SIR database and we have scored atfull implementation (80-100%) this year (May 2015 through current)

In order to link leadership team implementation to staff perceptions it is important for your school to regularly complete the RtI All Staff Perceptions Survey in addition to the SIR.

Did your school complete the RtI All Staff Perceptions Survey in the 2015-16 school year?

(Note: completing the RtI All Staff Perception Survey is not a requirement of recognition.)

Yes

No

Section 6: Student Level Data

If you selected Mathematics or Reading above:

Reading/Mathematics ScreeningData

Please provide us with as much of your reading or mathematics screening data for at least one grade and years from 2013 to 2015 as you can.

(We are looking for the # of students at benchmark each year. For example, the # of students meeting benchmark in nth grade in Fall 2015 and # of students meeting benchmark in nth grade in Spring 2015.)

If possible disaggregate by # with and without disabilities and race. Please indicate NA in the boxes that you need to leave blank.

Pick which grade level(s) you would like to submit for your reading or mathematics screening data (need to submit at least one grade level).

Grade 3  Other Grade Level

Grade 5  High School Graduation Data

Grade 8

*At least 1 year of data (Fall/Spring 2015) is required to qualify for Merit.

**At least 2 years of data (Fall/Spring 2015 and Fall/Spring 2014) by race and disability is required to qualify for Distinction.

Complete the following grade-level tables associated with how

you answered the above questions.

What is the name of the screening tool/measurement used for the data to be reported in the Reading Grade 3 table?

Note: We are looking for screening data over the past 3 years. Use the screening tool that provides the most data over this period.

Reading Grade 3

Please indicate NA in the boxes that you need to leave blank.

Fall 2015 / Spring 2015 / Fall 2014 / Spring 2014 / Fall 2013 / Spring 2013
Total # of students enrolled
Total # of students screened
# of all students screened and meeting benchmark
# of students without disabilities meeting benchmark
# of students with disabilities meeting benchmark
# of American Indian/Alaskan Native students meeting benchmark
# of Asian students meeting benchmark
# of Black students meeting benchmark
# of Hispanic/Latino students meeting benchmark
# of White students meeting benchmark
# of Native Hawaiian/Other Pacific Islander students meeting benchmark
# of Multi-racial students meeting benchmark
# of English Language Learners meeting benchmark

What is the name of the screening tool/measurement used for the data to be reported in the Reading Grade 5table?

Note: We are looking for screening data over the past 3 years. Use the screening tool that provides the most data over this period.

Reading Grade 5

Please indicate NA in the boxes that you need to leave blank.

Fall 2015 / Spring 2015 / Fall 2014 / Spring 2014 / Fall 2013 / Spring 2013
Total # of students enrolled
Total # of students screened
# of all students screened and meeting benchmark
# of students without disabilities meeting benchmark
# of students with disabilities meeting benchmark
# of American Indian/Alaskan Native students meeting benchmark
# of Asian students meeting benchmark
# of Black students meeting benchmark
# of Hispanic/Latino students meeting benchmark
# of White students meeting benchmark
# of Native Hawaiian/Other Pacific Islander students meeting benchmark
# of Multi-racial students meeting benchmark
# of English Language Learners meeting benchmark

What is the name of the screening tool/measurement used for the data to be reported in the Reading Grade 8 table?

Note: We are looking for screening data over the past 3 years. Use the screening tool that provides the most data over this period.

Reading Grade 8

Please indicate NA in the boxes that you need to leave blank.

Fall 2015 / Spring 2015 / Fall 2014 / Spring 2014 / Fall 2013 / Spring 2013
Total # of students enrolled
Total # of students screened
# of all students screened and meeting benchmark
# of students without disabilities meeting benchmark
# of students with disabilities meeting benchmark
# of American Indian/Alaskan Native students meeting benchmark
# of Asian students meeting benchmark
# of Black students meeting benchmark
# of Hispanic/Latino students meeting benchmark
# of White students meeting benchmark
# of Native Hawaiian/Other Pacific Islander students meeting benchmark
# of Multi-racial students meeting benchmark
# of English Language Learners meeting benchmark

What is the name of the screening tool/measurement used for the data to be reported in the Mathematics Grade 3 table?

Note: We are looking for screening data over the past 3 years. Use the screening tool that provides the most data over this period.

Mathematics Grade 3

Please indicate NA in the boxes that you need to leave blank.

Fall 2015 / Spring 2015 / Fall 2014 / Spring 2014 / Fall 2013 / Spring 2013
Total # of students enrolled
Total # of students screened
# of all students screened and meeting benchmark
# of students without disabilities meeting benchmark
# of students with disabilities meeting benchmark
# of American Indian/Alaskan Native students meeting benchmark
# of Asian students meeting benchmark
# of Black students meeting benchmark
# of Hispanic/Latino students meeting benchmark
# of White students meeting benchmark
# of Native Hawaiian/Other Pacific Islander students meeting benchmark
# of Multi-racial students meeting benchmark
# of English Language Learners meeting benchmark

What is the name of the screening tool/measurement used for the data to be reported in the Mathematics Grade 5 table?

Note: We are looking for screening data over the past 3 years. Use the screening tool that provides the most data over this period.

Mathematics Grade 5

Please indicate NA in the boxes that you need to leave blank.

Fall 2015 / Spring 2015 / Fall 2014 / Spring 2014 / Fall 2013 / Spring 2013
Total # of students enrolled
Total # of students screened
# of all students screened and meeting benchmark
# of students without disabilities meeting benchmark
# of students with disabilities meeting benchmark
# of American Indian/Alaskan Native students meeting benchmark
# of Asian students meeting benchmark
# of Black students meeting benchmark
# of Hispanic/Latino students meeting benchmark
# of White students meeting benchmark
# of Native Hawaiian/Other Pacific Islander students meeting benchmark
# of Multi-racial students meeting benchmark
# of English Language Learners meeting benchmark

What is the name of the screening tool/measurement used for the data to be reported in the Mathematics Grade 8 table?

Note: We are looking for screening data over the past 3 years. Use the screening tool that provides the most data over this period.

Mathematics Grade 8

Please indicate NA in the boxes that you need to leave blank.

Fall 2015 / Spring 2015 / Fall 2014 / Spring 2014 / Fall 2013 / Spring 2013
Total # of students enrolled
Total # of students screened
# of all students screened and meeting benchmark
# of students without disabilities meeting benchmark
# of students with disabilities meeting benchmark
# of American Indian/Alaskan Native students meeting benchmark
# of Asian students meeting benchmark
# of Black students meeting benchmark
# of Hispanic/Latino students meeting benchmark
# of White students meeting benchmark
# of Native Hawaiian/Other Pacific Islander students meeting benchmark
# of Multi-racial students meeting benchmark
# of English Language Learners meeting benchmark

For which Other Grade Level are you entering data?

What is the name of the screening tool/measurement used for the data to be reported in the

Other Grade Level table?

Note: We are looking for screening data over the past 3 years. Use the screening tool that provides the most data over this period.

Other Grade Level

Please indicate NA in the boxes that you need to leave blank.

Fall 2015 / Spring 2015 / Fall 2014 / Spring 2014 / Fall 2013 / Spring 2013
Total # of students enrolled
Total # of students screened
# of all students screened and meeting benchmark
# of students without disabilities meeting benchmark
# of students with disabilities meeting benchmark
# of American Indian/Alaskan Native students meeting benchmark
# of Asian students meeting benchmark
# of Black students meeting benchmark
# of Hispanic/Latino students meeting benchmark
# of White students meeting benchmark
# of Native Hawaiian/Other Pacific Islander students meeting benchmark
# of Multi-racial students meeting benchmark
# of English Language Learners
meeting benchmark

High School Graduation Data

Please provide us with as much of your High School Graduation data from 2013 to 2015 as you can. If possible disaggregate by # with and without disabilities and race.

*At least 1 year of data (2014-2015) is required to qualify for Merit.

**At least 2 years of data (2014-15 and 2013-14) by race and disability is required to qualify for Distinction.

Please indicate NA in the boxes that you need to leave blank.

2014-15 / 2013-14 / 2012-13 / 2011-12
Total # of students eligible to graduate
Total # of students graduating
# of students without disabilities graduating
# of students with disabilities graduating
# of American Indian/Alaskan Native students graduating
# of Asian students graduating
# of Black students graduating
# of Hispanic/Latino students graduating
# of White students graduating
# of Native Hawaiian/Other Pacific Islander students graduating
# of Multi-racial students graduating
# of English Language Learners graduating

Using data to drive systems level improvements:

After entering your academic achievement data above, describe how your team (regularly) reflects on and uses this data and what improvements or specific actions were taken. Specifically, highlight improvements for all students or subgroups of students.(3,000 character maximum)

In order to implement a culturally responsive multi-level system of support it is important to begin looking at both student achievement and behavior data and disaggregate it by student subgroups. We ask that you share your behavior (office disciplinary referral) data with us.

Are you willing to share your Office Disciplinary Data?

 Yes

 No - not willing to share data at this time/no data available

Office Discipline Referrals by Year

Please provide us with as much of your office discipline data by year from 2010 to 2015 as you can. When possible disaggregate by # with and without disabilities and race. Please indicate NA in the boxes that you need to leave blank.

Year to Date 2015-16 / 2014-15 / 2013-14 / 2012-13 / 2011-12 / 2010-11
Total # of students enrolled
Total # of ODRs
Total # of students with ODRs
# of students with 0-1 referrals
# of students with 2-5 referrals
# of students with 6+ referrals
# of students without disabilities with 1 or more ODRs
# of students with disabilities with 1 or more ODRs
# of American Indian/Alaskan Native students with 1 or more ODRs
# of Asian students with 1 or more ODRs
# of Black students with 1 or more ODRs
# of Hispanic/Latino students with 1 or more ODRs
# of White students with 1 or more ODRs
# of Native Hawaiian/Other Pacific Islander students with 1 or more ODRs
# of Multi-racial students with 1 or more ODRs

Section 7: Narratives

1. Based on the area in which you are applying,

A. Describe how your school identifies underserved groups of students (i.e. disproportionately identified students with disabilities, students of color, English language learners, etc.) and

B. Describe the culturally responsive practices put in place at the universal level to systemically address the areas of disproportionality identified.

Consider the following practices: instructional practices, staff professional development opportunities, imaging and affirmations, using data to change system practices/policies, etc.(3,000 character maximum)

2. Based on the area in which you are applying, provide specific examples of how you actively engage families in your school-wide implementation through collaborative decision making as evidenced by two-way communication. (3,000 character maximum)

3. Based on the area you are applying for, describe the process your school uses to determine need and match selected and intensive supports (interventions and additional challenges) for students. Include who (team), when, what data is used, how decisions are made and examples of what supports are provided.(3,000 character maximum)

Section 8: Recognition Information

Enter the school name that you would like on your recognition banner. (25 characters maximum) (PLEASE BE SURE YOU HAVE THE CORRECT SPELLING, IT WILL APPEAR EXACTLY AS ENTERED.)