Date Received: Meeting Date: Appendix #2: Form B Lake Shore Central Schools Confidential RtI Team Observation Checklist Check all that apply. Speech Reading Stutters Difficulty with letter names Difficulty articulating speech sounds Other: Difficulty with letter sounds Difficulty with phonemic awareness Difficulty with phonics Memory Limited reading vocabulary Difficulty retaining information over time Dysfluent reading Difficulty remembering what is seen Difficulty with reading comprehension Difficulty remembering what is heard Other: Other Written Expression Difficulty with writing speed Difficulty with spelling Difficulty with writing mechanics Difficulty expressing thoughts in writing Difficulty organizing thoughts in writing Skills Other: Difficulty with coordination Difficulty with body space awareness Mathematics Difficulty with letter formation Difficulty understanding number sense Difficulty with spacing Difficulty with basic operations Letter/number reversals Difficulty with Addition fact fluency Difficulty copying from the board/book Difficulty with Subtraction fact fluency Difficulty with directional tracking Difficulty with Multiplication fact fluency Other: Difficulty with Division fact fluency Difficulty solving word problems Attention and/or Organization Other: Difficulty with organization Easily distracted Listening Comprehension Difficulty beginning a task Difficulty understanding spoken language Difficulty completing a task Difficulty following verbal directions Under-active/lethargic Other: Loses or forgets work/materials Overactive/excessive motor movements Oral Expression Difficulty following classroom routines Homework not completed and turned in Difficulty expressing thoughts and Limited speaking vocabulary Other: Social/Emotional
Date Received: Meeting Date: Appendix #2: Form B Lake Shore Central Schools Confidential RtI Team Observation Checklist Check all that apply. Reading Difficulty with letter names Difficulty with letter sounds Difficulty with phonemic awareness Difficulty with phonics Limited reading vocabulary Dysfluent reading Difficulty with reading comprehension Other: Written Expression Difficulty with writing speed Difficulty with spelling Difficulty with writing mechanics Difficulty expressing thoughts in writing Difficulty organizing thoughts in writing Other: Mathematics Difficulty understanding number sense Difficulty with basic operations Difficulty with Addition fact fluency Difficulty with Subtraction fact fluency Difficulty with Multiplication fact fluency Difficulty with Division fact fluency Difficulty solving word problems Other: Listening Comprehension Difficulty understanding spoken language Difficulty following verbal directions Other: Oral Expression Difficulty expressing thoughts and Limited speaking vocabulary Other: Speech Stutters Difficulty articulating speech sounds Other: Memory Difficulty retaining information over time Difficulty remembering what is seen Difficulty remembering what is heard Other Skills Difficulty with coordination Difficulty with body space awareness Difficulty with letter formation Difficulty with spacing Letter/number reversals Difficulty copying from the board/book Difficulty with directional tracking Other: Attention and/or Organization Difficulty with organization Easily distracted Difficulty beginning a task Difficulty completing a task Under-active/lethargic Loses or forgets work/materials Overactive/excessive motor movements Difficulty following classroom routines Homework not completed and turned in Social/Emotional
RtI%20Plan%20K-5%20Lake%20Shore%20approved%2010-22-15.docx