RTI/Student Intervention Team CONFERENCE FORM (revised 10

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RTI/STUDENT INTERVENTION TEAM CONFERENCE FORM
Follow-up Meeting # _____
Student
Teacher
Grade
Meeting date
DOB
UPDATE OF ONGOING INTERVENTIONS/RESULTS
BASED ON THIS REVIEW, THE SIT TEAM HAS DETERMINED THAT:
ACTIONS/RECOMMENDATIONS
PERSON RESPONSIBLE
1. Achievement is noted; continue with interventions,
strategies, accommodations or modifications
TIMELINE
____________
______ 2. Implement additional interventions. Review Possible
Solutions and/or brainstorm additional solutions to implement.
Record additional interventions on the Ongoing Intervention Record.
______
______ 3. A disability is not suspected and the student will not be
evaluated. Prior Written Notice completed and sent to the parent. (Meeting #2 or later)
______
______4. Request more information/screenings (Meeting #2 or later)
______
_____ 5. Determine if the student is eligible for protection and/or an
accommodation plan under Section 504. (Meeting #3 or later)
______
______6. Refer to Exceptional Student Education to determine
if student qualifies for services as a child with a disability.(Meeting #3 or later)
______
Complete an Evaluation Review/Compliance Check Request form and use as cover sheet to send packet to
the ESE Office for ESE compliance check.
Next meeting scheduled for ______________________________ (date).
SIGNATURES
Name
Position
Date
revised 10-2010
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