Tier 2/Tier 3 (Secondary/Tertiary) Interventions Tracking Tool School Name: ______School Total Pop as of October 1:______

Intervention Brief Function-based Complex/Multiple-life Check-in Check-out (CICO) Modified CICO, Targeted Behavior. & Mentoring s Interventions -domain FBA/BIP

PBIS Indiana Center on Education & Lifelong Learning/Equity Project Indiana University 2010 {T2/T3 ITT} Page 1 of 1 # Students # Students # Students # Students # Students # Students # Students # Students # Students # Students Participating Responding Participating Responding Participating Responding Participating Responding Participating Responding July August Septembe r October November December January February March April May June Data-based Decision-rules for defining “response to intervention”: Please list below your data-based decision-rule to determine youth ‘response’ for each of the five levels of intervention. Ex. Students received 80% or better on Daily Progress Report for 4 consecutive weeks. Responding to Check-in Check-out (CICO): Responding to Social/Academic Instructional Groups: Responding to CICO with Modified Features, Targeted Behavior, & Mentoring Responding to Brief Function-based Interventions: Responding to a Complex/Multiple-life -domain FBA/BIP:

PBIS Indiana Center on Education & Lifelong Learning/Equity Project Indiana University 2010 {T2/T3 ITT} Page 2 of 1