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__**Demographic Information/Areas of Concern:

Demographic Information**__**: Fill in first and last name of student, date of team meeting and grade student is currently in. Check box by team member's name or write team member's name in the space provided.**

__**Areas of Concern:**__ **This is a general statement describing the social, emotional, behavioral and/or academic areas of concern(s). Give specific examples of the areas of concern. For example, "Johnny is two years behind in reading compared to his peers. His reading comprehension and inability to focus and pay attention in class are main contributors to Johnny's reading difficulties. Socially Johnny is struggling as he continues to offend his peers by making derogatory comments about other student's family members during unstructured time."**

__**Targeted Skill/Behavior:**__ **This section is where you will describe the specific focus of your intervention(s).**

__**Intervention:**__
 * At the initial CSP team meeting, the team will identify the problem(s) the student is experiencing in the regular classroom setting.** **From this general list of problems, the team will define specific target skills/behaviors to be the focus of intervention design.** **Once the problems have been identified, team members may need to conduct additional assessments or collect additional data prior to defining specific target skills.** **The referring teachers are to provide data collected in the classroom so the target skill/behavior can be described in observable and measurable terms.** **The target skill/behavior should be defined in terms of frequency, duration, and/or intensity in order to facilitate intervention design and outcome measurement.**
 * Intervention planning begins by setting a goal directly related to the identified target skill/behavior.** **Goals should be meaningful, measurable, easy to monitor and list how instruction is being provided differently from whole class instruction targeting specific skills or behaviors assessed on a regular basis. Interventions should be developed to enable the child to be involved in, and progress in, the general curriculum.**

__**Person Responsible:**__
 * Staff member(s) with responsibility for implementing and monitoring direct services for the intervention. Monitoring must be done with fidelity and integrity of the designed intervention. Students and parents cannot be listed as responsible persons as all interventions are to be provided by school staff.**

__**Frequency:**__
 * List how often (frequent) the intervention is to be provided to the student by listing the number of sessions per day, week or month.**

__**Duration:**__
 * Is the anticipated length of time that the intervention will be provided to the student (day, weeks, quarter, semester, year).**

__**Response to Intervention will be Measured by:**__
 * List the assessment tools that will be used, the data that is to be collected and how it is to be compared to baseline data or peer performance levels.**

__**Student's Current Performance/Baseline Data**__**: Using the established method for measurement recorded in "Response to Intervention Will be Measured by" above, record the student's current (baseline) performance level for the targeted skill/behavior.**

__**Student's Benchmark:**__ **List the anticipated performance level of the student as it directly relates to the intervention. What is the "aim" line or performance level the student will be expected to demonstrate.**

__**Expected Performance (peer norm for grade/class):**__
 * What typical students are expected to know and be able to do for the targeted skill/behavior.**

__**Results:**__
 * Data corresponding with baseline measures of skills targeted for interventions. This information is used to determine the student's progress towards meeting academic and/or behavior expectations/goals.**

__**Outcomes:**__ **Check "Goal Met" or "Making Progress" if the determined goal has been met or if acceptable progress is being made. In some cases, the intervention may not have worked as it was intended, Select "Revised Intervention" if a new intervention needs to be developed to achieve the established goal.**

__**Accommodations:**__ **Accommodations are changes in the way that material is presented to the student or in the way a student responds to the material (a student may dictate their responses to questions instead of writing them), as well as changes in setting, timing and scheduling.** **Accommodations involve many kinds of techniques, strategies, and support systems.** **They help students work around limitations related to their difficulties.** **An accommodation refers to “how” the general education curriculum will be presented to the student so that he/she can understand the general education curriculum. Accommodation may include: Visual schedules****, n** **ote taker/assistive technology, sensory regulations items, and visual organizers. Accommodations should not be confused for instructional interventions which incorporate direct academic or behavior teaching that are monitored and student performance that is measured by the outcome of the instructional intervention.**

__**Additional Assessments Needed**__**: If the team believes that additional information is needed to fully appraise the areas of concern or student's ability levels, the team will list the areas of assessment that will be conducted before the next CSP team meeting.**