Baseline Assessment Data for Academics and Social Development

Student:

Date:
FAST Academic Data

Date

Assessment #

Score

Achievement Level

Additional Reading Assessments (Unit Tasks, Pilot Material Assessments, Running Records, etc.)
Date

Assessment
Type

Score

Achievement
Level

Date

Assessment
Type

Score

Achievement
Level

Math Assessments (Benchmarks, Finals, Topic Tests, IXL, etc.)

Date

Assessment
Type

Score

Achievement
Level

Date

Assessment
Type

Score

Achievement
Level

SAEBRS/BIMAS UA Data
Date

Assessment
Type

Score

Risk Category

Date

Assessment
Type

Score

Risk Category

Current CELDT Testing

Date

Grade

Listening

Speaking

Reading

Writing

Overall
Score

Level

Check all classroom interventions previously done and/or refer to MTSS Intervention Logs
Tier 1
Universal Access
Common Flexible Groupings
Differentiation/SDAEI/Accommodations (Explain)_________________________________________________
FASTBRIDGE- Universal Screening
Other: ___________________________________________________________________________________

Replaces Forms D-1/D-2

Page 2 of STEP Intervention Packet

6-6-2016