Rti Surveys and forms

Appendix 6: Information on Reading Instruction and Intervention

for Sample of Students

Several students at the school have been selected to gather more information about their reading instruction. The questions below ask about a single student referred to as the “focal student.” You have been sent this form because you are listed as the classroom teacher for the focal student listed below.

Directions: This form has two sections: Part A (4 questions) and Part B (3 questions). It should only take a few minutes to answer the questions. Please complete this form daily for 5 consecutive days. We will repeat this two more times throughout this school year.

FOCAL STUDENT:

[Insert Name]

There are no expected answers, so please be honest as you respond. Your participation is confidential. Thank you in advance for completing this form.

All information gathered for this study will be kept confidential and will only be used for research purposes. The information collected about schools and students for this study will be used only for statistical purposes and may not be disclosed or used, in identifiable form, for any other purpose except as required by law (Public Law 107-279, Section 183).

According to the Paperwork Reduction Act of 1995, no persons are required to respond to this voluntary collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1850-New. The time required to complete this information collection is estimated to average 90 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Jonathan Jacobson, U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Suite 500J, Washington, D.C. 20208, or email [email protected].

PART A

The purpose of the following 4 questions is to understand instruction during the core reading block for the focal student, and any additional reading instruction beyond the core reading block for the focal student.

“Core Reading Block” refers to the regularly scheduled reading instruction given to all students. “Reading Instruction” refers to instruction in phonemic awareness, phonics, fluency, comprehension, and vocabulary. It does not include grammar, writing, or spelling instruction.

A1. Today, how many minutes did the focal student spend in reading instruction (i.e., phonemic awareness, phonics, fluency, comprehension, and vocabulary) during the core reading block. Do not include time spent in writing instruction (i.e., grammar, writing, or spelling).

____ # Minutes Adult-Led Small Group Reading Instruction ____ # Minutes Partner/Group Work without an adult ____ # Minutes One-to-One Adult-Led Tutoring in Reading ____ # Minutes Independent Work in Reading ____ # Minutes Other Reading Instruction (e.g., computer, whole group) _[Auto Sum?]__ # Total Minutes of Instruction During Core Reading Block Today

If more than 0 minutes, skip to Question A3.

A2. Please mark the reason(s) why you recorded 0 minutes in Question 1.

• Focal student was absent

• I was absent

• School was not in session (e.g., vacation period)

• There was a field trip, assembly, visitor, or other special event

• Focal student participated in standardized testing/test preparation

• Focal student received “pull out” instruction during the core reading block

• Other: _____

A3. In addition to the time listed in Question A1, how many minutes of additional small group intervention did the focal student receive today? This is sometimes called tier 2 or tier 3 and may be provided by you or another adult at the school.

____ # Minutes Additional Reading Intervention

If 0 minutes, then Stop here.

A4. Who provided this additional small group intervention today?

I did Another adult at the school [List name providing intervention and send Part B to Intervention Provider]

If you provided this intervention, then continue to Part B. Otherwise, stop here.

PART B – Teacher Directed Small Group Intervention

The purpose of the following 3 questions is to understand the adult-directed small group intervention that occurred in addition to the core reading instruction for the focal student today. This reading intervention is sometimes called tier 2 or tier 3. These questions are not about the small groups that typically occur as part of class-wide reading instruction.

.

B1. Including the focal student, how many students were in the reading group during adult-directed small group intervention today?

___ # Students

B2. What types of readers were in the focal student’s adult-directed small group intervention (check all that apply to today’s group)?

• At or above grade level benchmarks in reading

• Somewhat below grade level benchmarks in reading

• Far below grade level benchmarks in reading

B3. What was the content focus of the focal student’s adult-directed small group intervention today (select one answer per row)?

	A major focus	A minor focus	Touched on briefly	Not taught today
Phonemic awareness				
Phonics/Word Attack				
Fluency				
Reading comprehension				
Vocabulary				

Thank you for completing this form today. Please complete this same form daily for 5 consecutive days.

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