ࡱ> _ ybjbjuu 4f0b0bnn86Dzf:2444444$ ^XXHmR22X7tLbj0-!-!-!8XX-!nB : Form 210-5School Level Intervention Process Pre-Referral ChecklistInsert School Name, Address, Town, Sask., Postal Code Phone: (Number) Fax: (Number) email address if applicableReferenceAP 210 Services for Students With Diverse NeedsRevisedSeptember 14, 2018LevelSchoolSubmit toStudent Support TeacherWhenAs required (Adapted from: Guidelines for the Practice of Professional Psychology in Schools in Saskatchewan) When teachers have concerns about a students lack of progress, there are many things they can do to support the student. It is important to intervene as soon as the teacher recognizes that a student is falling behind. Please refer to the following suggested guidelines to develop a classroom intervention plan prior to referring the child for a comprehensive student services assessment. DateReview cumulative file for information. Collect data on student through informal assessment, observation, and discussion with previous teachers. Consider the students learner profile. Ensure vision, hearing, and medical assessments are up to date. Document observations of students. Identify areas of strength and weakness. Discuss concerns with the Triad (Administrator, PeBL Mentor, and Student Support Teacher) and/or parents/guardians. Implement intervention strategies in area(s) of need. Monitor progress. If the student continues to struggle, access the in-school Student Support Team for further strategies. Monitor progress. If the student continues to struggle, contact the Student Support Consultant to discuss specific areas of difficulty. A recommendation to consult with the Student Support Services Personnel may be suggested. Student Support Services personnel will provide additional intervention strategies based on the available data and/or may recommend the implementation of further informal assessment in addition to intervention strategies. Implement suggested intervention plan. Monitor progress. If the student continues to struggle, refer the students for a complete Student Support Services assessment. 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