1. Section 1A Classroom Teacher/Counselor Students in General Section 1B School Administrator Education Section 2A & 2B Classroom Teacher/Interventionist Classroom Teacher/Interventionist 4. Appendix A Tier II NOTE: Complete social emotional/behavior checklist only if needed Classroom Teacher/Interventionist 5. Appendix D Classroom Teacher/Interventionist 6. Appendix F NOTE: Complete checklist for Pre-K students only if needed Classroom Teacher/Counselor 1. Section 1A Students in General Section 1B School Administrator Education Section 2A & 2B Classroom Teacher/Interventionist Section 3A Classroom Teacher/Interventionist Tier III Section 3B & 3C Classroom Teacher/TST NOTE: Skip IEP section Classroom Teacher/Interventionist 6. Appendix A NOTE: Complete social emotional/behavior checklist only if behavior is identified as deficit area. 7. Appendix D Classroom Teacher/Interventionist Classroom Teacher/Counselor 1. Section 1A Students in Special Section 1B School Administrator Education Section 3B & 3C Classroom Teacher/TST/IEP Team * NOTE: Include IEP section Template Intensive Classroom Teacher/ TST/IEP Team Appendix D Interventions Classroom Teacher/Interventionist Appendix E K-4 *Note: Complete only if 3rd grade student applying for Good Cause Exemption Classroom Teacher/Counselor Section 1A Students with Dyslexia Section 1B School Administrator Section 2A & 2B Classroom Teacher/Interventionist Classroom Teacher/Interventionist Section 3A Classroom Teacher/TST Section 3B & 3C Teacher and Parent Appendix C Classroom Teacher/Counselor Section 1A English Language School Administrator Section 1B Learners (ELL) ELL Teacher Appendix B
1. Section 1A Classroom Teacher/Counselor School Administrator Classroom Teacher/Interventionist Classroom Teacher/Interventionist NOTE: Complete social emotional/behavior checklist only if needed Classroom Teacher/Interventionist Classroom Teacher/Interventionist NOTE: Complete checklist for Pre-K students only if needed Students in General Education Section 1B Section 2A & 2B Tier II 4. Appendix A 5. Appendix D 6. Appendix F 1. Section 1A Classroom Teacher/Counselor School Administrator Classroom Teacher/Interventionist Classroom Teacher/Interventionist Classroom Teacher/TST NOTE: Skip IEP section Classroom Teacher/Interventionist NOTE: Complete social emotional/behavior checklist only if behavior is identified as deficit area. Classroom Teacher/Interventionist Students in General Education Section 1B Section 2A & 2B Tier III Section 3A Section 3B & 3C 6. Appendix A 7. Appendix D 1. Section 1A Classroom Teacher/Counselor School Administrator Classroom Teacher/TST/IEP Team * NOTE: Include IEP section Template Classroom Teacher/ TST/IEP Team Classroom Teacher/Interventionist *Note: Complete only if 3rd grade student applying for Good Cause Exemption Students in Special Education Section 1B Section 3B & 3C Intensive Interventions K-4 Appendix D Appendix E Students with Dyslexia Section 1A Section 1B Section 2A & 2B Section 3A Section 3B & 3C Appendix C Classroom Teacher/Counselor School Administrator Classroom Teacher/Interventionist Classroom Teacher/Interventionist Classroom Teacher/TST Teacher and Parent English Language Learners (ELL) Section 1A Section 1B Appendix B Classroom Teacher/Counselor School Administrator ELL Teacher