REM Teacher form .pdf
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REM: Teacher Information
Student: ________________________
Meeting Date: ______________
General Education Teachers: _____________________
Most Recent Report Card Grades
Math
______________________
PST Interventions
Reading
Science
Social Studies
Math Work Samples
TYPE OF ASSESSMENT
DATE
GRADE
Accommodations
proximity seating small group instruction
use of manipulatives
DATE
Reading/Writing Work Samples
TYPE OF ASSESSMENT
writing assistance
revisions extended time reduced work
GRADE
assistive technology: _________________
other: ____________________________
Prong I: Documentation of Appropriate Instruction
The student has participated in a research based reading program.
The student has participated in a research based math program.
The student has participated in small group instruction.
The student received standards based instruction by a highly qualified teacher.
The student has participated in a school enrichment program.
The student has participated in a tutorial program.
The student has participated in a private educational program.
The student has received private speech therapy services.
The student’s data has been reviewed & appropriate instructional strategies
have been implemented in the classroom based on the student’s needs.
Other: ____________________________________________________
Prong II:
Running Record Benchmarks
Level Grade Equivalent
WPM
st
1 9 Weeks
2nd 9 Weeks
3rd 9 Weeks
4th 9 Weeks
Prong II: Tier 3 Math Data
Skill
Date
% Correct
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