Chapter 4 - Implementing a System of Research-based Interventions

Chapter 4 Implementing a System of Research-Based Interventions
Sample Written Intervention Form from St. Croix River Education Team
Note: Intended as guidance only.
Student: ______________________ Plan Development Date: ____________
Intervention #: 1 2 3 _______
Area of Concern: Reading Math Writing Behavior
Goal: _______________________________________________________________
INTERVENTION
Brief Description:
Description of
Needed Materials:
Intervention
Implementer:
When:
Where:
How Often:
Training to take
place:
Data Collection
System:
MEASUREMENT SYSTEM
Data Collector:
What Will Be
Recorded?
Frequency of Data
Collection:
When will Data be
Collected?
DECISION MAKING RULE
Slope / Trend Analysis Consecutive Data Point Rule
Level of Performance Other:
Intervention Start Date:
____________________________________________________________
Review Date: ______________ Time: __________ Place: _________
Note: See your team’s requirements for formatting and writing style.
Minnesota Department of Education Draft 4-34