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Eastern Elementary School SST Record

Student:

Teacher:

Grade:

Classroom Teacher Provides Brief Statement of Concerns:


Underline all that apply and elaborate:
Phonemic Awareness

Phonics Fluency

Vocabulary

Comprehension

Math

Behavior/Social

Additional Area of Concern(s)_____________________________________________

Classroom Teacher Gathers Information for Classroom Interventions


Actions

Information Obtained

Review Cum Folder

Parent Contact Information


Date

Contact
Method

Information Shared/Outcomes

Classroom Teacher Gathers Information for Current Academic Progress


Subject
ELA
Math

Benchmark Data, RIT, F&P, Classroom Performance

Classroom Teacher Implements and Monitors Classroom Interventions


(Behavior & Academic - Utilize Your PRIM)
Actions

Start Date

Statement of Results

Tier II Academic Interventions student has participated in:


Intervention
Interventionist Time Period

Teacher notes:
SST Notes from Meeting held on

Results

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