SAT Checklist

Pre-referral Documentation (must be completed and submitted prior to initial SAT meeting):

_____ Tier I Interventions

_____ Tier II Interventions

_____ Other documentation forms as necessary.

_____________________________________________________________________________

Initial SAT Meeting

Date: _______________

_____ Vision/Hearing Screening completed prior to meeting

Passed Vision: Yes No Passed Hearing: Yes No

_____ Teacher Observation Form

_____ Special Area Observation Form

___ Art ___ Music ___ PE ___ Speech

___ Reading ___ ESOL ___ SPECTRA ___ Other

_____ Tier III

_____ Other documentation forms as necessary.

Action taken: ___ Continue Interventions ___ Modify Interventions ___ Exit from SAT

Follow-up SAT Meeting

Date: _______________

_____ Tier III Updated

_____ Other documentation forms as necessary.

Action taken: ___ Continue Interventions ___ Modify Interventions

___ Refer to EC ___ Exit from SAT

Follow-up SAT Meeting 2

Date: _______________

_____ Tier III Updated

_____ Other documentation forms as necessary.

Action taken: ___ Continue Interventions ___ Modify Interventions

___ Refer to EC ___ Exit from SAT

EC Referral

_____ SAT paperwork submitted to EC – date: ________________