Jackson County School District
Teacher Support Team Checklist
The purpose of this checklist is to serve as a guideline for effectively implementing the TST process
according to Mississippi Department of Education guidelines and procedures.
□ 1. Referring Teacher Gathers Information:
 Student Observation
 Identification of Learning Styles
 Consults with student’s parents/guardian, faculty members, and other professionals
 Reviews student records
 Identifies students strengths/weaknesses
□ 2. Referring Teacher(s) Completes the Following Forms and Forwards Forms to TST
Interventionist:
 TST-1 (Request to Teacher Support Team)
 TST-2 (Student Data Sheet)
 TST-3 (Tier One Documentation)
 TST-4 (Tier Two Documentation)
 TST-5 (Tier Two Areas of Concern Checklist)
 IF BEHAVIORAL CONCERNS ARE EVIDENT:
TST-B1 (Behavioral Strategies Implemented Prior to Referral to TST: One per teacher)
TST-B2 (Social Emotional Worksheet: One per teacher)
□ 3. TST Interventionist Requests the Hearing and Vision Screening:
 TST-6 (Hearing and Vision Request Form: Fax or Email to JCSD Nurse)
□ 4. Administrator / TST Interventionist / or Designee Conducts the Initial TST Classroom Observation:
 TST-7 (TST Classroom Observation Report)
 IF BEHAVIORAL CONCERNS ARE EVIDENT
TST Interventionist will review TST-B1 and TST-B2 and have appropriate personnel complete
a. TST-B3 (Functional Behavior Assessment)
b. TST-B4 (Behavior Improvement Plan)
□ 5. TST Interventionist Schedules Initial TST Meeting and Sends Home Background From:
 Appendix A (Parent Invitation to Initial Meeting)
 TST-8 (Student Background Information)
 Appendix Form D (Confirmation of Meeting) Email Appendix Form D to administrator(s),
teacher(s), and applicable personnel regarding date and time of meeting.
Mandatory and alternate team members:
a. Classroom teacher (s) who work with the student: Mandatory Member(s)
b. Administrator or His/Her Designee: Mandatory Member
c. ELL Teacher: Mandatory Member if student is classified as ELL
d. Gifted Teacher
e. Speech/Language Pathologist: Mandatory Member if student has a current disability
f. School Nurse: Recommended if medical concerns are evident
g. Student, if appropriate
h. Positive Behavior Specialist
i. Other Appropriate Personnel
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Jackson County School District
Teacher Support Team Checklist
□ 6. Initial
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TST Meeting is Conducted:
TST Interventionist will review the TST procedures with parent(s) and members present.
Collect TST-8 form from parent/guardian
If applicable, have parent complete Appendix B (Release of Information)
Review all data gathered by teacher(s) with parent/guardian and TST:
a. Forms TST 1 through 7
b. Review TST-8 (Background Information) for questions or elaboration.
c. If applicable, TST-B1-B4. Appropriate personnel must attend meeting to explain
information.
Identify and Implement Interventions for Tier III.
Complete TST-9 (Initial TST Meeting Summary Form)
Complete TST-10 (Initial Intervention Documentation for Tier III) and sign
Schedule second TST meeting.
□ 7. Tier III Interventions Implemented by Referring Teacher(s):
 Implement interventions as outlined in TST-10
 If applicable, implement interventions outlined in TST-B4
 Review data weekly
 Report any concerns to the TST Interventionist via email weekly if applicable.
 Evaluate interventions and chart/label progress weekly
□ 8. Second Tier III Meeting:
The TST interventionist will schedule a second TST meeting for the purpose of
evaluating the effectiveness of the interventions and student progress:
 Send Appendix Form C (Parent Invitation to Subsequent TST Meetings)
 Email Appendix Form B (Confirmation of Meeting) prior to meeting
 Review all data gathered by teacher(s) with parent/guardian and TST:
a. Form TST 10
b. Any other gathered data
 Determine effectiveness of the intervention (mark appropriate box on TST-10):
a. Planned intervention was successful in meeting the child’s needs.
 Intervention will continue in the current setting
 Progress will be monitored
 Student will not move to a secondary Tier III intervention
b. Planned intervention was not successful in meeting the child’s needs.
 Complete form TST-12 (Secondary Intervention Documentation for Tier III)
 Schedule subsequent TST meeting.
● Complete and sign TST-11 (Secondary Meeting Summary Form)
□ 9. Tier III Interventions Implemented by Referring Teacher(s):
 Implement interventions as outlined in TST-12
 If applicable, implement interventions outlined in TST-B4
 Review data weekly
 Report any concerns to the TST Interventionist via email weekly if applicable.
 Evaluate interventions and chart/label progress weekly
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Jackson County School District
Teacher Support Team Checklist
□ 10. Final Tier III Meeting
The TST interventionist will schedule a final TST meeting for the purpose of evaluating the
effectiveness of the interventions and student progress:
 Send Appendix Form D (Final Parent Invitation to Subsequent TST Meetings)
 Email Appendix Form B (Confirmation of Meeting) prior to meeting
 Review all data gathered by teacher(s) with parent/guardian and TST:
a. Form TST 12
b Any other gathered data. If applicable TST-B1-B5
 Determine effectiveness of the intervention (mark appropriate box on TST-12):
a. Planned intervention was successful in meeting the child’s needs.
 Intervention will continue in the current setting
 Progress will be monitored
b. Planned intervention was not successful in meeting the child’s needs.
 Review with parents the referral to possible Child Study procedures.
 Complete form TST-15 (Referral to District Teacher Support Team)
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Complete TST-13 (Final Tier III Meeting Form)
□ 11. Complete Final Classroom Observation: TST-14.
□ 12. TST Interventionist will prepare packet to submit to Jackson County District TST.
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