District School Board of Pasco County Rev. 7/14

District School Board of Pasco County Rev. 7/14 Team Analysis of Data

Date of Receipt of Parental A. Meeting Date: Consent:

B. Demographic Information: Student Name: DOB: School: Grade: ID #: Current Eligibilities/Related Services: Vision Screen: Hearing Screen: Previous Ineligibilities and/or Discontinuations: Retention History: Parent Contacts: Subgroups:

Identified Areas of Concern that have been targeted for intervention:

Relevant Medical Findings: (documented)

Other Relevant Information:

Intervention Summary for the targeted area of concern: Check if interventions are waived. Interventions cannot be waived for Language Impaired and Specific Learning Disabilities (K- 12). Indicate the rationale for waiving interventions under the instructional details of educational need. Intensive Interventions were not implemented based on the data collected. FBA/BIP were implemented if behaviors impacted the student in the educational environment. Implementer/ Duration/ Instruction/Intervention Start Date and End Date Title Frequency Name/Basic Education Academic Example: Brainchild, Harcourt 3x per week for 30 Teacher Story town materials, Scott Foresman minutes, one-on-one science text, Title 1 materials- focus on vocabulary and comprehension (repeating instruction and previewing I Name/Classroom teacher and n Behavior Example: Modeling of targeted 2x per week, 1:1 ratio Name/SLP te speech goals, initiating conversation, and n expressing needs and emotions to peers si and teachers v e Social Stories targeting 1) expressing needs Daily, 1:1 ratio and emotions to peers and teachers without having meltdowns and 2) initiating Name/SLP conversation

Analysis of Response to Intervention Data (See attached, which includes graphs and documentation of parent involvement. Performance discrepancy (Attach graphed data): District School Class AYP Sub Group Other (e.g., Tier II, III Peer Group) *Minimally, Class data, Tier 2 and Tier 3 peer data required – data can be submitted and graphed by zoned school if necessary

Rate of Progress (Attach graphed data representing intervention intensity, rate of progress, expected rate of progress) *Depicted in graphs and shared at TAD presentation prior to staffing

Is there evidence of fidelity in the implementation of the interventions? Additional Information (if applicable):

The student’s response to intervention was . Additional Information (if applicable): Comments:

Formal Assessment and Need:

Standardized Norm-Referenced Instrument(s) Results: *If any- include here

Instructional Details of Educational Need: *What strategies/ accommodations the student has responded positively to and should continue to be implemented