[Electronic version.]
School District
Student code Student name or psuedonym
Birthdate (Day/Mo/Yr)
Parent perm. confirmed
Yes/No
Gender
M/F
ELL/ESL
Yes/No
1. Why did you/your team choose this student? (point form; key points only)
Teacher name or psuedonym
Grade
Aboriginal
Yes/No
2a. What do you know about this child’s reading/literacy? (incl. reading/oral performance levels, along with anecdotal comments; please include comments about comprehension/understanding)
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2b. What else do you need to find out about the child’s language/literacy/reading in order to create a strong plan for improving the child’s reading/literacy? (please be specific as this will be a key step in your immediate plan)
3a. What strengths, capacities, and/or “passions” do you see in this child? (at least 3)
Note: please include strengths from any domain or aspect, including social-emotional; self-regulation; physical/motor; aesthetics; passionate interests; at least one should be directly related to reading/literacy
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3b. What questions do you/your team have about this child’s strengths and capacities? What do you need to learn more about, in order to offer powerful support (e.g., social-emotional learning; self-regulation; engagement; interests; relationships; previous experiences …)
4. The child’s voice. Please talk with the child about his/her literacy/reading, and record some of his/her responses. Include direct quotes if you can.
( e.g., What do you like about books and stories? What do you think you are good at when it comes to reading/talking/listening? What makes you a good learner? What helps you learn? Consider including other domains, interests, etc.)
5. List the first FIVE words or phrases that come to mind when you think about this child today. In doing this, consider the “whole” child – all domains and aspects.
Attach any evidence or samples that help to create a picture of the child at this point – but not too many! (Collect less; think more!)
CR4YR 2013-2014

 Filled out during the second meeting by teacher/team
 This page is primarily designed to help you (a) plan, (b) track what happens, (c) look back and reflect on changes.
 “Baseline”
 One per child—if 2-3 of you are working together focusing on the same child, just one cover sheet
 You can work on this as a paper document or an electronic document (WORD) during the meeting, but you will be submitting it as an electronic document.
 Record just key points – these are modified, ‘mini’ cases – not full case records.
Remember that your record will be one of over 200 that we will combine and synthesize – we want your highlights. (One of our mottoes is: Collect less; think more.)
 Please keep a copy of the cover sheet for your use and reference throughout the project
CR4YR 2013-2014