RtI Tools & Forms

Forms listed below are designed to help schools analyze RtI-specific data, track degree of RtI implementation, and organize their RtI process into a school or district plan. Some data forms include webcasts that more fully describe how to complete each form.

Websites

The Measured Effects website has a variety of free tools, forms, and templates for Tier 1, Tier 2, and Tier 3 instruction.  These forms include, but are not limited to the following: Inventory Analyzer for Words Their Way, Tier 2 Behavior - Small Group Intervention data template, Weeks to Close the Gap chart.

Data Forms

This tool can be used to document the average benchmark score of specific student populations. Its purpose it to help schools determine if students are improving over time on general outcome measures that are considered key indicators of overall reading achievement. Click on "View .XLSX" to access the electronic tool. 

A  short video tutorial provides directions on how to complete the Benchmark Tracking Form.

This electronic tool answers the question: What is the average Rate of Improvement (ROI) for student groups between two benchmark periods? This tool allows schools to calculate ROI among different student subtypes, by grade level and literacy measure and compare their student’s growth to normative growth rates. Click on the "View .XLSX" to access the electronic tool. 

A short video tutorial provides directions on how to complete Rate of Improvement Form.

This electronic tool answers the question: What percentage of students scored within the low-, some, and at-risk levels across benchmark periods? Its purpose is to help schools evaluate the impact of their RtI process by examining the percentage of different student populations students scoring at different risk levels by grade and early literacy measure from one benchmark period to the next. Click on the "View .XLSX" to access the electronic tool. 

A short video tutorial provides directions on how to complete the Risk Level Status Form.

Using this electronic tools provides schools with the ability to determine: How many students moved to a less or more intensive tier between benchmark periods? The tool tracks the percentage of multiple student populations at each tier by grade level from one benchmarking period to the next. Click on the "View .XLSX" to access the electronic tool. 

A short video tutorial provides directions on how to complete the Tiered Intervention Form.

Benchmark Data Tools

This data form allows you to view benchmark data across four grades (i.e. 5-8) in one graph.  It can be used with any program.

RtI Forms & Templates

This guidance document can be used as a protocol to structure Individual Problem Solving meetings.

This recording form is to be used in conjunction with the Individual Problem Solving Meeting Protocol.

This referral form can be used to refer students for an Individual Problem Solving meeting.

NYS RtI MS DP Assessment Audit

New York State Response to Intervention MS Demonstration Project

A comprehensive assessment system will involve multiple and varied types of evaluative tools designed to provide information that guides and informs instruction. The RtI Assessment Audit is a review of assessment practices implemented by a school in the area of literacy across grade levels. Conducting a RtI Assessment Audit serves several purposes:

1. Identifies the different types of assessments used in the area of literacy
2. Clarifies the purpose (screening, progress monitoring, diagnostic, and outcome) of each assessment tool
3. Identifies the construct being assessed (e.g.. concepts of print, comprehension, fluency, etc..), 
4. Identifies training needs of staff members relative to the administration and interpretation of targeted assessments;   
5. Provides an opportunity for a school to identify redundancies or gaps in the assessment process.

This guidance document can be used as a protocol to structure Post Benchmark meetings.

This recording form is to be used in conjunction with the Post Benchmark Meeting Protocol.

This guidance document can be used as a protocol to structure Progress Monitoring meetings.

This recording form is to be used in conjunction with the Progress Monitoring Meeting Protocol.

Section 100.2(ii), added to Part 100 of the Commissioner’s Regulations, set forth minimum requirements for using an RtI process to determine a student’s response to research-based intervention. One of the minimum requirements outlined requests districts to establish a plan and policies for implementing school-wide approaches and pre-referral interventions [8 NYCRR section 100.2(ii)]. The Response to Intervention Plan Template for Individual Districts provides guidance for documenting your district’s RtI framework and implementation process.

Section 100.2(ii), added to Part 100 of the Commissioner’s Regulations, set forth minimum requirements for using an RtI process to determine a student’s response to research-based intervention. One of the minimum requirements outlined requests schools to establish a plan and policies for implementing school-wide approaches and pre-referral interventions [8 NYCRR section 100.2(ii)]. The Response to Intervention Plan Template for Individual Schools provides guidance for documenting your school's RtI framework and implementation process.

RtI Action Plan

New York State Response to Intervention MS Demonstration Project

After completing the NYS RtI Readiness Survey with your entire school staff and analyzing the results, the RtI Core Design Team will use this form to identify specific RtI indicators that need attention or modification. 

 

RtI Core Design Team

New York State Response to Intervention MS Demonstration Project

Use this form to record your RtI Core Design Team members and their positions. These members could include, but are not limited to, principal, other administrative positions, literacy coach, reading teacher, interventionist/AIS provider, general education teacher, special education teacher, ESL teacher, psychologist, speech pathologist, and parent.

RtI Tiered Descriptor

New York State Response to Intervention MS Demonstration Project

The NYS RtI Tiered Descriptor Form allows schools to list programs the school is currently using, the interventionist, frequency of the program, and the duration at tiers 1, 2, and 3.

RtI Survey Tools

This document is an appendix to the Abridged and Unabridged RTI Survey tools.

NYS RTI/MTSS Self-Assessment Survey for Middle School (Unabridged Version)

New York State Response to Intervention MS Demonstration Project

This survey was developed to examine your school's current RtI/MTSS practices.  You may need to download the "glossary of terms" document as an appendix.

This survey was developed to examine a school's current RtI/MTSS practices.  You may need to download the "glossary of terms" document as an appendix.

The New York State Self-Assessment Tool for RtI Readiness and Implementation was developed by consortium members of the NYS Response to Intervention Middle School Demonstration Project (NYS RtI MS DP) in collaboration with personnel from the New York State Education Department P-12, Office of Special Education. As a self-assessment tool, it is intended to:(1) assist individual schools/districts in evaluating their current level of RtI readiness and implementation and 2) formulate a RtI Implementation plan that will address RtI indicators that require improvement or development. It offers an opportunity for the school community to engage in reflective conversations around the topic of RtI.

This version is the updated version (2019) of the tool developed in 2013.

This document is designed for use in elementary schools.  For the Middle School version, please see the appropriate versions (unabridged and abridged).

This tool is intended for use by a school’s or a district’s RtI Design Team for the purposes of:
1. summarizing and analyzing the results from the NYS Self-Assessment Tool for RtI Readiness and Implementation
2. prioritizing RtI elements or features in terms of importance or priority
3. using results to construct an implementation plan that will guide the RtI process in their respective schools/districts

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