BROWNSVILLE INDEPENDENT SCHOOL DISTRICT
RESPONSE TO INTERVENTION PROCESS
CASE MANAGER CHECKLIST
Student:
DOB:
ID#:
Gr.:
Date on RTI-1:
Monitoring Teacher:
Assigned Chair/Case Manager:
Counselor or Designee:
Campus:
After the Initial RtI Referral has been received, the following steps must be taken:
TASKS TO BE COMPLETED PRIOR TO INITIAL RTI MEETING
DATE
COMPLETED
Request student’s teachers to complete Form RTI-1 later than:
(Date)
Tally all individual RTI-1forms onto one master
Compare previous report card(s) with current grades
Compare previous TAKS scores (including Benchmark scores) with most current
scores
Examine cumulative folder for additional information (i.e., LPAC information, etc.)
Examine attendance records for patterns of absenteeism and/or tardies
Examine discipline folder and note behavioral patterns and/or consequences received
by the student, if any
Consult with nurse for current and/or past health information
Consult with administrator (if he/she has contact with student)
Consult with counselor (if he/she has contact with student)
Interview student, if appropriate
Other:
TASKS TO BE COMPLETED AFTER RTI MEETING
DATE
COMPLETED
Review IIP and/or PBSP with student
Review IIP and/or PBSP with appropriate staff
Make a schedule change, if appropriate
Consult with parent, if appropriate
Refer student and/or parent to community resources, if appropriate
Gather additional information, if requested, and prepare to present information at the
next RtI team meeting
Follow through and monitor to ensure plan is carried out in the manner it was intended
Periodically meet with the student to check on how student is progressing
Gather tracking sheets, anecdotal data, progress reports, etc. necessary to indicate
intervention progress/success
Other:
9-2009