SEMINOLE COUNTY PUBLIC SCHOOLS, FLORIDA
Multi-Tiered System of Supports (MTSS)
STUDENT SUMMARY OF INFORMATION REVIEWED
SCHOOL:
Student:
Date of Birth:
Area(s) of Academic Need: Reading
Other Area(s) of Need: Behavior
Confidential File:
504
ELL Program: 1st Year
Vision Screening: Pass
Math
Medical
ESE
Science
Attendance
3+ Years
Date:
Other:
Previous Retention:
Families in Transition (F.I.T.)
2nd Year
Fail
Writing
Grade:
Grade Retained:
Health Care Plan
Hearing Screening: Pass
Fail
Psychological Testing
Date tested:
Date tested:
Academic Assessments/Progress Monitoring Reports (PMRs):
*Please note that the referenced assessments/PMRs will not be applicable to all schools and/or grade levels. Reports for those assessments/PMRs should
be included as appropriate.
DISCOVERY
ERDA
4Sight
DAR
DIBELS
ORF
SRI
FCAT Results
CELLA
DRA
PSI
PASI
Writing Prompt
Other Assessments/PMRs Reviewed and Included
Academic Intervention Summary: Intervention Logs
Parent Conferences
Dates Met:
Tier II—(Core Instruction + 30 Min Intervention Daily): Reading: PA
Phonics
Fluency
Vocabulary
FCAT Math Strand: Algebra
Geometry/Measurement
Tier III—(Tier II Instruction + Additional Intervention Daily): Reading: PA
FCAT Math Strand: Algebra
Tutorial: Yes
No
Geometry/Measurement
SES Tutoring: Yes
Behavior Intervention Summary:
SCPS 1453 (Rev.09/24/12) FED
Phonics
Fluency
Numbers and Operations
Mentor: Yes
Intervention Logs
Parent Conferences
Tier II—Individual Intervention Strategies
Tier III—Individual Intervention Plan
No
Numbers and Operations
No
Comprehension
Data Analysis
Vocabulary
Other
Comprehension
Data Analysis
Summer School: Yes
Other
No
Discipline File
Dates met:
Behavioral Observations
Behavioral Observations
Functional Behavior Assessment
Behavioral Intervention Plan