NATIONAL TRAINING OF TRAINERS ON DEVELOPMENTALLY APPROPRIATE PRACTICES IN
EARLY LANGUAGE, LITERACY AND NUMERACY
Department of Education
January 26, 2016
REMEDIAL PLAN FOR MATH INTERVENTION
Name of Student: _______________________________________
Date of Birth: _______________________________________
Age: _______________________________________
School: _______________________________________
Grade Level: _______________________________________
Period of Remediation: _______________________________________
Number of Hours: _______________________________________
Number of Program: _______________________________________
Schedule: _______________________________________
Reason for Referral
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Background Information
Pertinent History: ______________________________________________________________________
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Diagnosis:
DATE PROFESSIONAL NAME IMPRESSIONS
Other Remarks: ________________________________________________________________________
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Behavioral Observations
STRENGTHS WEAKNESSES GOALS
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STATUS BEFORE REMEDIATION
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Noted Areas of Difficulty
Directional confusion Spatial awareness Speed of work
Sequencing Short-term and Math language
problems working memory Conceptual ability
Visual–perceptual Long-term memory Positive view of
difficulties Math
REMEDIAL PLAN
General Goal: _________________________________________________________________________
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Area: Number Concept (__________________________________________)
Strengths Weaknesses Goals & Methods
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Area: Fact-Retrieval and Mental Computation (__________________________________________)
Strengths Weaknesses Goals & Methods
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Remedial Plan for Math 2
Area: Number Computations (__________________________________________)
Strengths Weaknesses Goals & Methods
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Area: Math Language and Documentation (__________________________________________)
Strengths Weaknesses Goals & Methods
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Area: Applications (__________________________________________)
Strengths Weaknesses Goals & Methods
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Prepared by:
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Remedial Plan for Math 3
