SUPPLEMENTAL INTERVENTION DOCUMENTATION FORM

Intervention Area: Reading Writing Math Behavior Social-Emotional

Student Name: Harry Potter 2nd Grade Person Providing Intervention: Classroom Teacher

Start Date: 9/25/2023 Review Date: 10/30/2023

Goal: Harry will increase his words read correct per minute from 26 wcpm to 40 wcpm
within 4 weeks.
DATE M T W T F SKILLS/ACTIVITIES COMMENTS PM DATA
9/25 X Collect baseline data Harry is reading approximately 9/29:
using Oral Reading 26 words correct per inute on
9/27 X
WEEK 1

Fluency CBM probes average with 96% accuracy. 26 wcpm

9/29 X
25th percentile when compared
to ORF norms.

10/2 X Implemented Repeated Harry is reading 28 wcpm after 10/6:

Reading Intervention 1 week of intervention
10/4 X
WEEK 2

15 min per session, 3x per 28 wcpm

10/6 X week 96% accuracy

10/9 X Continue implementing Harry is reading 33 wcpm after 10/13:

Repeated Reading 1 week of intervention
10/11 Student absent
WEEK 3

Intervention 15 min per 33 wcpm

10/13 X session, 3x per week 97% accuracy

10/16 X Continue implementing Harry is reading 35 wcpm after 10/20:

Repeated Reading 1 week of intervention
10/18 X
WEEK 4

Intervention 15 min per 35 wcpm

10/20 X session, 3x per week 96% accuracy
WEEK 5