APPENDIX H Part 3 Chapter 41: Intervention Details the instructional model that the Mississippi Department of Education requires districts to follow, which consists of three (3) tiers of instruction. Recommendations for Documentation The chart below provides recommended guidance for selecting the appropriate forms needed to document the essential components of a Multi-Tiered System of Supports. STUDENTS IN GENERAL EDUCATION: TIER II Required Components Recommended Data Collector Section 1A, 1B, or 1C Section 1D Section 2A, 2B, & 2C Appendix A Appendix D Appendix E Appendix G Classroom Teacher/Counselor School Administrator Classroom Teacher/Interventionist Classroom Teacher/Interventionist * NOTE: Complete social emotional/behavior checklist if needed. Classroom Teacher/Interventionist Classroom Teacher/TST/IEP Team Classroom Teacher/Interventionist * NOTE: Complete checklist for Pre-K students only if needed. STUDENTS IN GENERAL EDUCATION: TIER III Tier III Required Components Recommended Data Collector Section 1A, 1B, or 1C Section 1D Section 2A, 2B, & 2C Section 3A Section 3B, 3C & 3D Appendix A Appendix D Appendix E Appendix F Classroom Teacher/Counselor School Administrator Classroom Teacher/Interventionist Classroom Teacher/Interventionist Classroom Teacher/TST * NOTE: Skip IEP section Classroom Teacher/Interventionist * NOTE: Complete social emotional/behavior checklist if behavior is identified as deficit area. Classroom Teacher/Interventionist Classroom Teacher/TST/IEP Team * NOTE: Applies to students in K-4 with a reading deficiency. Classroom Teacher/Interventionist * NOTE: Complete only if 3rd grade student applying for Good Cause Exemption.
STUDENTS IN SPECIAL EDUCATION: INTENSIVE INTERVENTIONS K-4 Required Components Recommended Data Collector Section 1A, 1B, or 1C Section 1D Section 3B, 3C, & 3D Appendix D Appendix E Appendix F Classroom Teacher/Counselor School Administrator Classroom Teacher/TST/IEP Team * NOTE: Include IEP section Template Classroom Teacher/ TST/IEP Team Classroom Teacher/TST/IEP Team Classroom Teacher/Interventionist * NOTE: Complete only if 3rd grade student applying for Good Cause Exemption. STUDENTS WITH DYSLEXIA Required Components Recommended Data Collector Section 1A, 1B, or 1C Section 1D Section 2A & 2B Section 3A Section 3B, 3C, & 3D Appendix C Appendix E Appendix F Classroom Teacher/Counselor School Administrator Classroom Teacher/Interventionist Classroom Teacher/Interventionist Classroom Teacher/TST Teacher and Parent Classroom Teacher/TST/IEP Team * NOTE: Applies to students in K-4 with a reading deficiency. Classroom Teacher/Interventionist * NOTE: Complete only if 3rd grade student applying for Good Cause Exemption. ENGLISH LEARNER* Learners (ELL) Required Components Recommended Data Collector Section 1A, 1B, or 1C Section 1D Appendix B Appendix E Appendix F Classroom Teacher/Counselor School Administrator ELL Teacher Classroom Teacher/TST/IEP Team Classroom Teacher/Interventionist * NOTE: Complete only if 3rd grade student applying for Good Cause Exemption. *If English Learner (EL) students are in the Tier process it is recommended that Tier II and Tier III documentation is utilized as outlined for “Students in General Education.”