Student Name_____________________________ Grade _______ Tier_______ Teacher/Interventionist__________________________________
Behavior Data
PBIS Data
Teacher BIP
Behavior Contract
Guidance
Counselor
Referral
Social Worker
Referral
Excessive
Absences
Reading (ELA Data)
EOG Score______
Baseline Data
Imagine Reading
Classroom
Assessments
NC Check-Ins
Study Island
Diagnostic
Common Lit
Diagnostic
Math Data
EOG Score______
Baseline Data
Imagine Math
Classroom
Assessments
NC Check-Ins
Study Island
Diagnostic
Progress Record/Monitoring
Date:
Week:
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Focus/Intervention
Score
Baseline:
Date:
Week:
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Focus/Intervention
Score
Baseline:
Date:
Week:
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Week 7
Week 8
Focus/Intervention
Score
Baseline: