Baker: June 25th, 2015

Skill Assessment Scoring Sheet

Step 1 - Problem Identification

What is the replacement behavior or target skill? (measurable, observable, reportable)

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What percent of students are currently meeting the benchmark (be sure to include data that directly assesses the target skill you want the students to perform?

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Based on your analysis, which tier of intervention would be most appropriate to implement in response to the identified problem?

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Step 2 - Problem Analysis

HYPOTHESIS #1

Problem Analysis-1. Hypothesis #1

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Problem Analysis-2. Prediction Statement #1

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Problem Analysis-3. Relevant Data #1

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Problem Analysis-4. Validated #1

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HYPOTHESIS #2 (if completed)

Problem Analysis-1. Hypothesis #2

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Problem Analysis-2. Prediction Statement #2

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Problem Analysis-3. Relevant Data #2

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Problem Analysis-4. Validated #2

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HYPOTHESIS #3 (if completed)

Problem Analysis-1. Hypothesis #3

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Problem Analysis-2. Prediction Statement #3

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Problem Analysis-3. Relevant Data #3

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Problem Analysis-4. Validated #3

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HYPTHESIS #4 (if completed)

Problem Analysis-1. Hypothesis #4

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Problem Analysis-2. Prediction Statement #4

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Problem Analysis-3. Relevant Data #4

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Problem Analysis-4. Validated #4

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Step 3 – Intervention Design

The intervention strategy/strategies link directly to the hypotheses listed under the “Verified Hypotheses” column

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The intervention plan (see “Intervention Plan” column) contains enough information for the plan to be carried out

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The support plan (see “Support Plan” column) contains enough information for the plan to be carried out

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The documentation plan (see “Documentation” column) contains enough information for the plan to be carried out

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The plan for monitoring student progress (see “Monitoring Plan for Determining Student Progress” column) contains enough information for the plan to be carried out

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Step 4 – Response to Instruction/Intervention

Based on your review of the data, is the response to instruction/intervention positive, questionable, or poor? Please explain your rationale.

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What instructional decisions would you recommend based on the students’ response to instruction/intervention? Please explain your rationale.

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