Classroom Intervention Checklist for Student Referral

Student:                                                                                      Teacher:     

Please check the intervention strategies that have already been implemented:

PARENTS AS PARTNERS (at least 1 is required)   Date of contact

          Telephone conversation                                                    

          Voice message                                                                       

          Email                                                                                          

          Parent/teacher conference                                             

          Parent/teacher/student conference                           

          Other (specify):      

INSTRUCTIONAL ACCOMODATIONS

REINFORCERS/CONSEQUENCES

Small group instruction

Praise (specific and clear)

Breakdown of tasks in to smaller steps

Conference with student

Individualized classroom instruction

Positive call/email home

Individualized directions

Reinforce correct responses promptly

Change groupings

Behavior referral

Use alternate teaching modes

Clarification of expectations

Use alternate teaching modes

 

 

Modify rate

 

 

Allow alternate response models

CLASSROOM MANAGEMENT

Other (specify):      

Behavior referral

 

 

Model and practice classroom expectation (good teaching should happen every day)

 

Give specific options for compliance

 

Use logical consequences

 

Student teacher proximity

CURRICULUM ACCOMOODATION

Minimize distractions

Lower level of text

Move to a different seat

Recorded material

 

 

Modify or shorten assignments/homework

 

 

Specialized equipment or materials

 

Comments:      

Other (specify):      

 

 

DISTRICT/BUILDING SUPPORT

 

 

Peer Tutor (in-class)

 

 

Tutoring

 

 

Parent Volunteer

 

 

ELD/ELL

 

 

Title I

 

 

SPED

 

 

Attendance Support

 

 

Homeless Liaison

 

 

Indian Ed

 

 

Other- specify:      

 

 


Coos Bay Public Schools

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