Oregon RTIiIntensive SupportApplication 2015-2016

Section V: Signature Page

District Name: Date:
Primary Contact
______
NameTitle
______
EmailPhone Signature
The ______School District is applying to participate in Oregon RTIi’s Intensive Support Cadre beginning in the fall of 2015. My signature below indicates that:
  1. I have read and understand the Introduction to the Oregon RTIi application
  1. I have provided input on the application and agree with my district’s responses
  1. I am committed to participating in project training activities and moving my school/district forward on implementing a comprehensive RTI system for literacy in all elementary schools, including:
  2. Ensure non-negotiable prerequisites are in place (Universal Screener & Research Based Core Program)
  3. Teaming structures (District Leadership Team, District Implementation Team, Building Implementation Team)
  4. Standards of Practice in the following:
  1. A research based core curriculum and instruction for 60 minutes/day (based on a 5 day week)
  2. Assessment System (Universal screening, Progress Monitoring, Diagnostic, and Outcome/Mastery)
  3. Systematic and explicit interventions
  4. Data-based decision making and teaming practices
  5. The use of RTI for making SLD eligibility decisions in Math
  6. Provide training, support and monitoring to your district/school staff.
  7. Provide outcome and implementation fidelity data.
All signatures are required, including the principal from each elementary school.
NAME (TYPED OR PRINTED) SIGNATURE DATE
______
Superintendent
______
Director of Special Education (or equivalent)
______
Director of Curriculum & Instruction (or equivalent)
Oregon RTIiIntensive Support Application 2015-2016
Signature Page 2:All Elementary Principals
NAME (TYPED OR PRINTED) SIGNATURE DATE
______
Principal at ______
Elementary School
______
Principal at ______
Elementary School
______
Principal at ______
Elementary School
______
Principal at ______
Elementary School
______
Principal at ______
Elementary School
______
Principal at ______
Elementary School
______
Principal at ______
Elementary School
______
Principal at ______
Elementary School
______
Other: ______
______
Other: ______

Oregon RTIi 2015-2016 Intensive Support Application Page 1