Note: Interventionist refers to the individual(s) delivering the intervention. Student: DOB: Grade: 1. Describe the area being targeted for intervention and means of identifying the need. 2. Indicate the area(s) of suspected disability (interventions must match deficit areas of the disability suspected) : 3. Describe the Tier I intervention(s) implemented in the general education classroom to address the area being targeted and the name of the interventionist. Expected Progress Dates Impact Frequency (Where should the Amount of (What was the end result? of student have been at Time What was the Begin End Service the end of this level/score?) intervention?) 4. Describe the Tier II intervention which was implemented to address the area being targeted and name of the interventionist. Frequency Expected Progress Dates Amount of of Impact (Where should the Time Begin End Service student have been at
Note: Interventionist refers to the individual(s) delivering the intervention. Student: DOB: Grade: 1. Describe the area being targeted for intervention and means of identifying the need. 2. Indicate the area(s) of suspected disability (interventions must match deficit areas of the disability suspected) : 3. Describe the Tier I intervention(s) implemented in the general education classroom to address the area being targeted and the name of the interventionist. Dates Frequency of Service Amount of Time Impact (What was the end result? What was the level/score?) Expected Progress (Where should the student have been at the end of this intervention?) Begin End 4. Describe the Tier II intervention which was implemented to address the area being targeted and name of the interventionist. Dates Frequency of Service Amount of Time Impact Expected Progress (Where should the student have been at Begin End
SLD%20Eligibility%20Guidance%20Document-3.docx