Tier 2 Criteria Checklist: Grade 3
Use this checklist to identify students who qualify to receive Tier 2 interventions.
Name: _________________________________
Grade: _______
Date: ______________
Classroom Teacher: _________________________
Tier 2: Entrance Criteria
Reading/Language Arts: Students must meet 4 of the 8 criteria below.
Check all
areas that apply.
Current level
SRI – below basic/basic
EasyCBM: Word Fluency – below 20%ile
EasyCBM: Passage Fluency – below 20%ile
EasyCBM: Comprehension – below 20%ile
DRA – below grade level
Reading/Language Arts report card grades of N or U
Teacher Observations (attendance & behavior)
Prior School Interventions/tracking data
Does this child meet 4 of the 8 criteria above?
Spring
520
46
83
11
O
o no
Check all areas that apply.
Current scores
Does this child meet 3 of the 5 criteria above?
Winter
425
36
83
9
M
o yes
Math: Students must meet 3 of the 5 criteria below.
MBSP: Math Computation – below 25%ile
MBSP: Math Application – below 25%ile
Math report card grade of N or U
Teacher Observations (attendance & behavior)
Prior School Interventions/tracking data
Fall
330
25
57
8
L
Fall
9
11
o yes
** Yes means assign an intervention in Tier 2.
** No means continue to differentiate during Tier 1 classroom instruction.
Winter
13
17
Spring
22
21
o no
Tier 3 Consideration Form: Grade 3
Students who fail to make adequate progress after at least 2 Tier 2 interventions, should be
considered for more intensive, Tier 3 interventions.
(Exceptions into Tier 3 can be made for students who are considerably below grade level.)
Name: _________________________________
Grade: _______
Date: ______________
Classroom Teacher: _________________________
Tier 2 Interventions:
Interventions
1.
2.
Dates
Data
Tier 2/3 Exit Criteria Checklist: Grade 3
Use this checklist to identify students who qualify to exit from Tier 2/3 interventions.
Name: _________________________________
Grade: _______
Date: ______________
Classroom Teacher: _________________________
Reading/Language Arts: Students must meet 5 of the 8 criteria below.
Check all
areas that apply.
Current scores
Fall
520
26
58
9
M
Winter
630
37
84
10
N
Spring
740
47
84
12
P
SRI – proficient
EasyCBM: Word Fluency – above 20%ile
EasyCBM: Passage Fluency – above 20%ile
EasyCBM: Comprehension – above 20%ile
DRA
Reading/Language Arts report card grades of S or higher
Teacher Observations (attendance & behavior)
Progress Monitoring Data showing gap closing (Trend line closer to intersecting with grade level proficiency line.)
Does this child meet 4 of the 8 exit criteria above?
o Yes
o Move to Tier 2
o No
o Fill out SST
o Exit
o Review/Change Intervention
or
or
Math: Students must meet 4 of the 5 criteria below.
Check all areas that apply.
Current scores
MBSP: Math Computation – above 25%ile
MBSP: Math Application – above 25%ile
Math report card grade of S or higher
Teacher Observations (attendance & behavior)
Progress Monitoring Data showing gap closing
Fall
10
12
Winter
14
18
Spring
23
22
(Trend line closer to intersecting with grade level proficiency line.)
Does this child meet 3 of the 5 exit criteria above?
o Yes
o Move to Tier 2
o No
o Fill out SST
or
or
o Exit
o Review/Change Intervention