<p> Mineola High School IST Protocol Initial Referral</p><p>Referral Form  Packet will be given to the teachers / team with a due date attached  Additional teachers (AIS, Specials, Foreign Language) will be given their part to fill in with a due date attached  Intervention List (attached to the referral form) o Team form o AIS Teacher’s form</p><p>Objectives/Strategic Intervention worksheet:  Objectives will be compiled by IST core members (using the data from the referral form) and filled into the worksheet prior to the meeting. Each Team member will be given a worksheet as the meeting begins.  Intervention List (to be present at the meeting for reference) o Teacher Developed List o Math o Reading o Behavior/Motivation/Study Skills</p><p>Initial Meeting Plan  To be filled in by IST Chairperson</p><p>IST Strategic Intervention Plan (copied from initial meeting plan)  Will be distributed to teachers once the plan is finalized (by IST Chairperson).  Follow- ups will be conducted by the guidance counselors to ensure fidelity of the plan (at least 3X during six week period)  Team members will be provided an additional copy of the plan (IST chairperson) 1 week prior to the follow up meeting as a reminder to gather data and organize results of the specific interventions in preparation for meeting. Mineola High School IST Task List</p><p>Student ______</p><p>Prior to Initial Meeting Date ______</p><p>Task Assigned to Status  Student IST Folder Created IST Chairperson</p><p> Referral Form Distributed IST Chairperson / Secretary  Referral Form Collected Guidance Counselor (1 week from distribution)  Completed Referral Sent to IST Chairperson Core Team for review  Objectives Determined IST Core Team</p><p> Objectives/Referral sent to IST Chairperson teachers for review and further input  Parent Contact Secretary  Meeting Date Set  Teachers / Team Notified  Written notification sent to Secretary parents explaining IST process and initial meeting date and time</p><p>IST Problem Solving Meeting Date ______</p><p>Task Assigned to Status  Objectives Reviewed IST Team  Specific Interventions Developed  Resources obtained IST Team  Provide supports for interventions (when needed) During Intervention Period Dates ______</p><p>Task Assigned to Status  Periodic Checkpoints (in order IST Chairperson 1: ______to maintain fidelity) 2: ______(3x in the course of the intervention period) 3: ______Results of Strategic Intervention IST Chairperson will Data put notices in Form will be put in mailboxes in mailboxes and over order for the teachers to fill in their email. results of the intervention using specific data. They will be asked to have it filled in with numbers and/or bring samples of response or no response to the intervention.</p><p>Follow Up Meeting Task List</p><p>Task Responsibility Status Interventions/Results of Interventions IST Team Reviewed Results Checklist:</p><p>___ Intervention was effective. No further actions necessary</p><p>___ Some Significant Concerns but Continue Monitoring Rates of Progress using Current Response to Intervention Strategies</p><p>___ Student is making progress with current interventions. Maintain current response to Intervention Strategies with some revisions.</p><p>___ Some Significant Concerns and Intervention Needs Modification (Interventions Modified and/or New interventions developed)</p><p>___ Significant Educational Needs and Insufficient Response to Intervention Requires Consideration of Committee on Special Education</p><p>___ Significant Educational Needs and Current Intervention may Be Effective but is Not Sustainable with Respect to Resource Time and Intensity</p><p>___ Requires Consideration of Committee on Special Education Adapted from AIMSWeb RtI Manual</p>