Problem Solving Process
Parent-School Partnership
Assessment and/or Intervention Form
Student’s Name:
Date of Birth:
School:
Parent’s Name:
Grade:
Date of Meeting:
(Please note: Parent-School Partnership form is to be reviewed
and discussed with a parent as a component of ongoing communication and student success planning.)
Dear Parent/Guardian,
Our school is committed to supporting student success. If a student experiences a specific need in
academics or behavior, it is important for school personnel and parents to work together. We want to
include you in the planning and monitoring of your student’s targeted interventions.
At this time, our Problem-Solving/Behavior Evaluation Team may conduct a variety of interventions
within the general setting. These focused/target interventions will be delivered in different levels of
intensity according to your child’s needs.
A record of your student’s assessment, interventions, and progress will be kept in a file at the school.
The quality and effectiveness of interventions for your child will be strengthened by your involvement.
Therefore, you will be given feedback as to the meaning and results of the assessments and
interventions and will receive information/ideas on how to support school success at home.
Specific Area of Concern: ___________________________________
Assessment Tool(s) and Staff Involved:___________________________________
_______________________________________________________________________
Intervention(s) and Staff Involved:________________________________________
Purpose of Assessment or Intervention: _____________________________
I understand that my child will be participating in a targeted assessment/intervention with the
appropriate school staff. I understand that I am invited to participate in the planning and monitoring
of my student’s school success as relates to these assessments and interventions. I understand that
I may request an evaluation for my child.
Parent/Guardian Signature
Telephone
Staff/School Contact
Date
Email
Phone
Revised 8/2014
Problem Solving Process
What is Response to Intervention (RtI) now called Multi-Tiered System of Supports (MTSS)?
RtI/MTSS is a process that provides interventions and educational support to all students at
increasing levels of intensity based on their individual needs. The goal is to prevent problems and
intervene early so that students can be successful. RtI/MTSS is a process designed to help schools
focus on interventions that are matched to student needs and monitored on a regular basis. The
information gained from the RtI/MTSS process is used by school personnel and parents to adapt
instruction and to make decisions regarding the student’s educational and/or behavioral plan.
Examples of educational and/or behavioral concerns include:
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Reading (mechanics, vocabulary, comprehension)
Math (applied math, calculation, facts)
Written language (spelling, organization, grammar)
Attention, listening, following directions
Behavior (following rules, complying with teacher requests, socializing with peers)
Work quality, homework completion
The Problem Solving Team:
The Problem Solving Team is comprised of parents and school staff who hold specific insights and
areas of expertise that can be used to help the student succeed.
Through the Problem Solving Team parents will:
 Be informed about interventions planned for your child.
 Be notified of the increase or decrease of support (academic and/or behavioral) depending on
your child’s needs.
 Receive regular progress monitoring reports about how your child responds to the
interventions provided.
Level of instruction/intervention:
Tier 1: Universal (core curriculum, school-wide behavior management, for all students.)
Tier 2: Targeted (supplemental small-group strategies for students provided in addition to
Tier 1.)
Tier 3: Intensive (highly-focused strategies, provided in addition to Tiers 1 and 2).
Revised 8/2014