intervention assistance team process - Stephen T. Badin High School

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IAT ReferralForm 2Student’s Name: ______________________________________________Teacher Making Referral: _______________________________________Dates Contacted Parent: ________________________________________Parent Making Referral: _________________________________________Concern(s) Discussed: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please list all <strong>intervention</strong>s/accommodations implemented, the length of eachand also any impact observed: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Attach all parent documentation, work samples, and/or any privatereports given to you by the parent.
IAT Counselor InformationForm 3Record Review: Attendance this year _______absent _______tardy Ever retained? Yes No Received any <strong>intervention</strong>s in elementary school?Yes____ No_____ If yes, ________________________ Previously evaluated? Yes _____ No _______ Any Health Conditions? Yes ______ No ______If yes, _________________________________________ Discipline Issues: Yes _____ No ______If yes, _________________________________________Medications: ___________________________________ Current Grades:Math ________________ Science _______________English _______________ Religion ______________History _______________ Elective 1 _____________Elective 2 ______________ Elective 3 _____________ Standardized Test Results: ________________________ Observations of Student:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Page 1 and 2: INTERVENTIONASSISTANCETEAM PROCESS
Page 3 and 4: Step 4 - Once all of the forms have
Page 5: Parent DocumentationForm 1Student
Page 9 and 10: 4. Interventions Provided: (Check a
Page 11 and 12: IAT OutcomeForm 5Concerns Discussed

intervention assistance team process - Stephen T. Badin High School

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