Brownsville Independent School District
Student:
D.O.B.:
ID#:
Grade:
Bilingual:
Campus:
Date:
RESPONSE TO INTERVENTION PROCESS
INDIVIDUAL INTERVENTION PLAN (IIP)
IIP Starting Date:
Phonological Awareness
(6-8 weeks)
IIP Ending Date:
Initial Tier 2 (IIP) 30 min. __ x day
TEKS FOCUS SKILL:
RTI 5
ELA/READING
Initial Tier 3 (IIP) 30 min. __ x day
SKILL TARGETED READING:
Phonics
Comprehension
Fluency
Vocabulary
Current Grade Average (Report Card Average):
INTERVENTION(S) TO BE IMPLEMENTED: (Need 2- 3 diverse interventions documented at each
Tier)
INTERVENTION PLAN:
DURATION:
Resource Used:
Title of Intervention Targeted ( TEK ):
Begins on:
Ends on:
Resource Used:
Title of Intervention Targeted ( TEK ):
Begins on:
Ends on:
Resource Used:
Title of Intervention Targeted ( TEK ):
Begins on:
Ends on:
ELL Classroom Interventions
Interventional Strategies
Categorizing
*RD MA
WR LA
SC
SS
Interventional Strategies
*RD MA
WR LA
SC SS
Interventional Strategies
Study Sheets/Guides
Computer Lab/Language
Dev. Programs
Individualized » Schedule
to meet progress reports
Linguistic
Accommodations
Extended Day/Saturday
Tutorial
Fluency Reinforcement
Manipulations - Hands on
experience/Foldable(s)
Note taking assistance
Grammar/Spelling
Pre-Teach Content
Vocabulary - flashcards,
charts, etc.
Reinforcing Contextual
Definition
Sheltered
Instruction/ELPS
Name Software:
Use of Visual
Cues/Thinking Maps
Use of Bilingual/Content
Dictionaries
Use of Cognates
Graphic
Organizers/Planners
Highlighting key words,
phrases/categories
Technology Software
__________________________________________
RtI Chairperson/Administrator
________________________________________
Counselor
*RD
WR
SC
Summer School
Word walls/ Label items
in the classroom
_______________________________
Teacher of Record
___________________________________
Dean/ Facilitator
MA
LA
SS
Brownsville Independent School District
Student:
D.O.B.:
ID#:
Grade:
Bilingual:
Campus:
Date:
RESPONSE TO INTERVENTION PROCESS
INDIVIDUAL INTERVENTION PLAN (IIP)
IIP Starting Date:
RTI-5
MATH
(6-8 weeks)
IIP Ending Date:
Initial Tier 2 (IIP) 30 min. __ x day
TEKS FOCUS SKILL:
Initial Tier 3 (IIP) 30 min. __ x day
SKILL TARGETED MATH:
Current Grade Average (Report Card Average):
INTERVENTION(S) TO BE IMPLEMENTED: (Need 2- 3 different interventions documented at
each Tier)
INTERVENTION PLAN:
DURATION:
Resource Used:
Title of Intervention Targeted ( TEK ):
Begins on:
Ends on:
Resource Used:
Title of Intervention Targeted ( TEK ):
Begins on:
Ends on:
Resource Used:
Title of Intervention Targeted ( TEK ):
Begins on:
Ends on:
ELL Classroom Interventions
Interventional Strategies
Categorizing
*RD MA
WR LA
SC
SS
Interventional Strategies
*RD MA
WR LA
SC SS
Interventional Strategies
Study Sheets/Guides
Computer Lab/Language
Dev. Programs
Individualized » Schedule
to meet progress reports
Linguistic
Accommodations
Extended Day/Saturday
Tutorial
Fluency Reinforcement
Manipulations - Hands on
experience/Foldable(s)
Note taking assistance
Grammar/Spelling
Pre-Teach Content
Vocabulary - flashcards,
charts, etc.
Reinforcing Contextual
Definition
Sheltered
Instruction/ELPS
Name Software:
Use of Visual
Cues/Thinking Maps
Use of Bilingual/Content
Dictionaries
Use of Cognates
Graphic
Organizers/Planners
Highlighting key words,
phrases/categories
Technology Software
*RD
WR
SC
Summer School
Word walls/ Label items
in the classroom
_________________________________________
RtI Chairperson/Administrator
___________________________________
Teacher of Record
________________________________________
Counselor
___________________________________
Dean/ Facilitator
MA
LA
SS
Brownsville Independent School District
Student:
D.O.B.:
ID#:
Bilingual:
Grade:
Campus:
Date:
IMPLEMENTATION OF INDIVIDUAL INTERVENTION PLAN (IIP)
AND/OR POSITIVE BEHAVIOR SUPPORT PLAN (PBSP)
SIGNATURE OF RECEIPT
RTI 6
DIRECTIONS: Attached is the Individual Intervention Plan (IIP) and /or Positive Behavior Support Plan
(PBSP) dated ________________. The interventions are recommended to be in place for
a period of 6-8 weeks prior to recommendation for further screening/assessment.
RtI Case Manager will have a record of receipt for audit purposes. Please read and sign
that you have received the Individual Intervention Plan (IIP) and/or the Positive Behavior
Support Plan (PBSP).
Response to Intervention Process
Progress Monitoring Record
RTI 7
Curriculum Based Monitoring Results (Scores) of Progress Monitoring
Probes: The teacher of record will provide the date and description of probes used to
monitor the student’s response to his/her intervention plan. Teacher will submit the
weekly grades entered on the gradebook to prove the effectiveness of intervention.
*ATTACH: Grades entered on the gradebook for area of concern.
SUCCESS/FAILURE TO RESPOND
YES
NO
NOTE: If the student does not demonstrate sufficient progress, an additional/revised intervention should be initiated and/or
more time for the initial intervention should be considered. After Tier 2 student can be referred to other services such as
dyslexia/504. After Tier 3 special education is an alternative option in some cases.
I.
COMMITTEE DECISION:
Student data indicates a need for academic and/or behavioral interventions through Tier 2 of the RtI
process.
Student data indicates student demonstrates need for more intensive interventions through Tier 3 of the
RtI process. Referral to Tier 3 or Section 504 (only if there is a suspected disability or referral is for
dyslexia assessment) shall be initiated. (Specify Tier 3 or §504)
Student data indicates student demonstrates little to no response to intervention through either Tier 2 or
Tier 3 of the RtI process. Referral to Tier 4 Special Education shall be initiated.
Student data indicates that there is no need for academic or behavioral interventions. Student will be
monitored on a regular basis for any changes in need.
_________________________________________
___________________________________
RtI Chairperson/Administrator
Teacher of Record
________________________________________
Counselor
___________________________________
Dean/ Facilitator
Brownsville Independent School District
Student:
D.O.B.:
ID#:
Bilingual:
Grade:
Campus:
Date:
Curriculum Based Monitoring Results: Provide weekly results student’s response to
intervention plan. Only use as many weeks to reflect the affixed timeline on student
individual plan. Leave the remaining weeks blank if doesn’t apply.
Brownsville Independent School District
Student:
D.O.B.:
ID#:
Bilingual:
Grade:
Campus:
Date: