Tier 3
Screen 1. Student Information: Data entered in eRTI by STAT
Screen 3. Tier 3 Intervention Plan: Input from teacher(s); data entered by STAT
into eRTI *Campus decision. Teachers can print and check the boxes that need to
be included in this screen and give to STAT main contact, put an “X” in the
checklists and email to STAT main contact, etc. Whatever works best for your
campus! This screen’s information entered should be a collaborative effort with
the whole STAT.
The Tier 3 Intervention Plan screen drop down menus are below and are also
located in a separate Word document (located on RTI website) to print out only
the checklists. These come directly from eRTI drop down menu banks.
Target Area(s) of Concern: Indicate the Target Area(s) of Concern
Target Area(s) of Concern
Academic Math
Academic Reading
Academic Writing
Behavior
Language/Communication
Physical
Social
Elaborate: Describe more specifically the target area of concern. This will be what the
intervention, goal statement, and RTI Plan will focus on.
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Interventions: Indicate which intervention(s) will be used. If one is not in the list, select other
and add the intervention.
Intervention(s)
Academic Math
Accelerated Math Live
Academic
Reading
Language Power (Teacher
Created Materials
Publishing)
Academic Math
Cognitive Tutor
Academic
Reading
Other ***Enter
Intervention here***
Academic Math
Do the Math
Academic
Reading
Read 180
Academic Math
FASTT Math
Academic
Reading
System 44
Academic Math
Academic Math
Academic Math
Math 180
Other ***Enter Intervention
here***
Targeted Mathematics
Intervention
Academic Writing
Academic Writing
Building Vocabulary
(Teacher Created Materials
Publishing)
Fountas & Pinnell Leveled
Literacy Intervention (LLI)
Academic Writing
Imagine Learning
Academic
Reading
Building Vocabulary (Teacher
Created Materials Publishing)
Academic Writing
Language Power (Teacher
Created Materials
Publishing)
Academic
Reading
Estrellita Espanol
Academic Writing
Other ***Enter
Intervention here***
Academic
Reading
Fountas & Pinnell Leveled Literacy
Intervention (LLI)
Academic Writing
Read 180
Academic
Reading
Imagine Learning
Academic Writing
System 44
Imagine Learning Espanol
Academic Writing
Imagine Learning Espanol
iStation
Behavior
CHAMPS
iStation Espanol
Other
**Add here**
Academic
Reading
Academic
Reading
Academic
Reading
Intervention Goal Statement: Type a goal statement in the text box. For help writing goal
statements, refer to RTI Writing SMART Goals on RTI website. (S — Specific M — Measurable A —
Achievable R — Realistic T — Time-based) The target area of concern, intervention, goal statement,
performance level, and goal/desired outcome should all correlate. Remember to compare apples to apples.
Current Performance Level: This must be a number. This can be a specific iStation ISIP score,
Lexile Measure, Quantile Measure, number of Dolch sight words read correctly, etc.
Goal/Desired Outcome/Level: This must be a number. This can be a specific iStation ISIP score,
Lexile Measure, Quantile Measure, number of Dolch sight words read correctly, etc. Remember to be
reasonable, review student’s trends, and consider all appropriate information. Remember this must
directly relate to the current performance level!
Total Number of Weeks: Indicate how many weeks STAT anticipates the student will need to
meet their goal/desired outcome/level with appropriate intervention(s). STAT should review
information and collaborate to determine this. If number of weeks is not listed, select NEW to enter in
number of weeks.
Total Number of Weeks
New
8
15
4
9
20
6
12
24
Minutes per Session: Indicate how many minutes per session of intervention the student will
receive. STAT should review information and collaborate to determine this. If number of minutes is not
listed, select NEW to enter in number of minutes.
Minutes per Session
New
30
10
45
20
55
Begin Date: Enter the date the intervention(s) will begin.
Number of Days per Week: Enter in the number of days per week the student will receive the
intervention(s).
Evaluation Method: Indicate the evaluation method that will be used to monitor progress and
determine if goal/desired outcome/level is met.
Evaluation Method
Attendance Reports
Data Collection
Informal Assessment
Intervention Program Assessment Score or Level
Lexile Measure
Observation
Progress Report
Quantile Measure
Location: Indicate where the intervention(s) will be provided. If location is not in the list, select
NEW to add a location.
Location
New
Cafeteria
Classroom
Counseling Office
Gym
Hallways
Staff Member Providing Intervention: Indicate the staff member that will be providing the
intervention.
Supporting Teaching Strategies/Comments: Indicate teaching strategies that are/will be used to
support the student and provide interventions. Comments can also be added to the text box in eRTI.
Supporting Teaching Strategies/Comments
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Adaptation of
Materials
Altered Format of
Materials
Assignment
Sheets/Assignment
Notebook
Calculator
Colored Overlays
Copy of Class Notes
ESL Materials
Highlighted Materials
Monitored Use of
Assignment
Planner/Notebook
Outlines and Study Guides
Peer Note taking
Peer to Read Materials
Provided Examples or
Work Samples for
Reference
Study Aids/Manipulatives
Supplemental/High
Interest Materials
Taped Texts
Use of Computer
Alteration of
Assignments
Reduced Assignments
Alteration of
Assignments
Special Projects in Lieu of
Assignments
Alteration of
Assignments
Alteration of
Assignments
Behavior
Management
Behavior
Management
Behavior
Management
Special Projects in Lieu of
Tests
Behavior
Management
Clearly Defined/Consistent
Limits
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Taped Assignments/Lecture
Assignment of Mentor or
Coach
CHAMPS
Classroom Rules Consistently
Enforced
Frequent Contact
Frequent Positive
Reinforcement
Frequent Reminder of Rules
Ignoring Minor Infractions
Implementation of Behavior
Contract
Logical Consequences
Model prosocial behavior
Opportunity to Help Teacher
Adaptation of
Materials
Alteration of
Assignments
Alteration of
Assignments
Alteration of
Assignments
Alteration of
Assignments
Alteration of
Assignments
Alteration of
Assignments
Alteration of
Assignments
Use of Graphic Organizers
Assistance in Class
Discussions
Copy of Lecture/Notes
Emphasis on Major Points
Exemption from Reading
Before Peers
Extra Time for Assignments
Group Projects
Hands-On Projects
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Behavior
Management
Alteration of
Assignments
Individual Contracts
Behavior
Management
Alteration of
Assignments
Opportunity to Respond
Orally
Behavior
Management
Alteration of
Assignments
Behavior
Management
Modification of
Environment
Modification of
Environment
Prioritized Assignments
Teacher and student
interaction is frequent
Minimize auditory
distractions
One to One Instruction
Modification
of Instruction
Modification
of Instruction
Behavior
Management
Modification
of Instruction
Parent Involvement of
Routines and Expectations
Personal Goal Setting
Posted Classroom Rules
Private Discussion Regarding
Behavior
Promote Time on Task
Proximity Control
Rewards or Token System
Role playing or modeling of
appropriate behavior
Routines and Daily Schedules
are Posted, Taught, and
Followed
Structured learning
environment to assist
students in attention and
focus
Oral Exams
Peer Tutoring
Supervision During Transitions
Provide Opportunities for
Guided Practice
Modification of
Environment
Preferential Seating
Modification
of Instruction
Reinforcement of Skills
Previously Taught
Modification of
Environment
Reduce Visual Stimuli
Modification
of Instruction
Repeat Instructions
Modification of
Environment
Small Group Instruction
Modification
of Instruction
Short Instructions
Modification of
Environment
Study Carrel
Modification
of Instruction
Simplify Vocabulary
Modification of
Environment
Use of Quiet Area
Modification
of Instruction
Small Group Testing
Modification of
Instruction
Auditory Aids
Modification
of Instruction
Study Sheets/Preview
Summaries
Modification of
Instruction
Break Down Skills into
Smaller Steps
Modification
of Instruction
Use of Computer
Modification of
Instruction
Check for Understanding
Modification
of Instruction
Use of Supplemental
Materials or Web-based
Programs
Modification of
Instruction
Cooperative Learning
Groups
Modification
of Instruction
Use of web page as a resource
Modification of
Instruction
Differentiated Instruction
Modification
of Instruction
Visual Aid
Modification of
Instruction
Direct Instruction of New
Concepts and Vocabulary
Modification
of Instruction
Written Instructions
Modification of
Instruction
Modification of
Instruction
Modification of
Instruction
Modification of
Instruction
Modification of
Instruction
Modification of
Instruction
Modification of
Instruction
Encourage Participation
Exams of Reduced Lengths
Short Answer
Extended "wait time"
Extra time for Oral
Response
Extra Time for Written
Response
Frequent and Immediate
Feedback
Multisensory Instruction
and Materials
Screen 5. Summary of Parent/Guardian Contact: data entered by STAT into eRTI
*Campus decision. Whoever contacts the parent (sends the letters/RTI
Plan/Documents home) needs to document the information from the screen
below. The data is entered by STAT into eRTI.