Lorain City Schools
Response to Intervention Team
Individual Attendance Plan
Student Name: Click here to enter text.
Grade Level: Click here to enter text.
Referral Date: Click here to enter text.
Number of hours leading to meeting: Click here to enter text.
Date of Meeting: Click here to enter text.
Review of the student’s attendance record:
A. Total number of hours absent: Click here to enter text.
B. Total number of days tardy: Click here to enter text.
Meeting Attendance: Please take attendance of the members of the RtI team, and who is in attendance at the meeting. (Check the box to the left of the person’s name in attendance to indicate they were at the meeting). Fill in the name of the person attending.
☐ School Administrator: Click here to enter text.
☐ Parent / Guardian: Click here to enter text.
☐ Student: Click here to enter text.
☐ Guidance Counselor: Click here to enter text.
☐ Teacher / Staff Member: Click here to enter text.
Participant Name: Job Title / Position:
☐ Participant: Click here to enter text. Click here to enter text.
☐ Participant: Click here to enter text. Click here to enter text.
☐ Participant: Click here to enter text. Click here to enter text.
☐ Participant: Click here to enter text. Click here to enter text.
☐ Participant: Click here to enter text. Click here to enter text.
Time Line for the RtI Team:
☐ 7 Days from triggering absence, RtI formed.
☐ District has made three good faith efforts to contact parents / guardians. (Provide documentation of these attempts.)
First attempt: Click here to enter text.
Second attempt: Click here to enter text.
Third attempt: Click here to enter text.
☐ 10 days from triggering absence, student is assigned to RtI team.
☐ 14 days from assignment of student, the RtI team will develop the intervention plan.
☐ 61st day, if no progress by the student, complaint filed with the juvenile court.
Contributing factors to absences:
Click here to enter text.
Plan for Intervention:
Click here to enter text.