You are on page 1of 3

Student Academic Support Plan

5th Grade

Elementary School
Student Name Grade Level Student Information Date of Birth Homeroom Teacher

Universal Assessment Information


Benchmarks M-Comp Date Score R-CBM Accuracy Date Score R-CBM Rate Date Score Date Maze Score Last Spring Fall Winter Spring Math Date Score Date Reading Score

AIMSweb

Benchmarks

STAR

Last Spring Fall Winter Spring Math Date RIT %ile Date Reading RIT %ile

Benchmarks

MAP

Fall Winter Spring

Areas of Concern
___ Not an area of concern at this time __ Phonemic Awareness __ Initial sound isolation __ Blending __ Segmenting Decoding __ Phonics __ Sounds for letters A-Z __ Letter combination sounds __ Word Identification __ High frequency words __ Automaticity __ Fluency __ Rate __ Accuracy __ Prosody __ Vocabulary __ Conversational __ Content __ Comprehension __ Summarizing __ Questioning __ Making Connections __ Visualization __ Text Structure __ Monitoring

Reading

___ Not an area of concern at this time


__ Operations & Algebraic Thinking __ Number & Operations in Base Ten __ Number Operations Fractions __ Measurement & Data

__ Geometry

Math

__ Writing & interpreting numerical expressions __ Analyzing patterns and relationships

__ Understanding place value __ Performing operations with multi-digit whole numbers and with decimals to hundredths __ addition __ subtraction __ multiplication __ division

__ Using equivalent fractions as a strategy to add and subtract fractions __ Apply and extend previous understanding of multiplication and division to multiply and divide fractions.

__ Converting like measurement units within a given measurement system __ Represent and interpret data __ Understanding concepts of volume and relating it to multiplication and addition

__ Graphing points on the coordinate plane to solve real-world problems __ Classify twodimensional figures into categories based on their properties

Additional Information:

Student Academic Support Plan Elementary School Student Name ___ Tier I (Core) ___ Tier II (Supplemental) ___ Tier III (Intensive)

Area of Concern: ______ Reading ______ Math Target area: Research Based Core Program Core Support Descriptor Small group instruction Leveled instruction Explicit instruction Engaging activities Scaffolding of instruction Additional practice opportunities Start Date: Research Based Intervention Targets: Setting # of sessions per week Length of session Small group ______ One-on-one Start Date: Research Based Intervention Targets: Setting # of sessions per week Length of session Small group ______ One-on-one Start Date: Research Based Intervention Targets: Setting # of sessions per week Length of session Small group ______ One-on-one Progress Monitoring Tool Name of Probe(s) Target Area # of times to be progress monitored

Area of Concern: ______ Reading ______ Math Target area: Research Based Core Program Core Support Descriptor Small group instruction Leveled instruction Explicit instruction Engaging activities Scaffolding of instruction Additional practice opportunities Start Date: Research Based Intervention Targets: Setting # of sessions per week Length of session Small group ______ One-on-one Start Date: Research Based Intervention Targets: Setting # of sessions per week Length of session Small group ______ One-on-one Start Date: Research Based Intervention Targets: Setting # of sessions per week Length of session Small group ______ One-on-one Progress Monitoring Tool Name of Probe(s) Target Area # of times to be progress monitored