HARRISON COUNTY SCHOOL DISTRICT
HIGH SCHOOL TST PROCESS
Tier I: Quality classroom instruction based on Mississippi Curriculum
Tier II: Focused Supplemental Instruction for students unsuccessful in Tier I.
Tier III: Intensive interventions specifically designed to meet the individual needs of the
student who has not been successful in Tiers I and II.
TST is recommended in the following situations:
MS laws mandate referral of a student in grades 4 – 12 to TST if the student has
previously repeated a grade and is repeating the current grade within the first 20
days of school.
A particular student shows signs of a serious academic deficit and the teacher has
taken steps to meet the student’s needs in Tier I and Tier II.
A particular student is exhibiting signs of serious emotional or behavioral
Prior to making a referral to the TST team, the teacher should evaluate the
student’s academic progression in Tier I, by considering the following factors?
Does the student have a special education ruling? If so, see the SPED
responsibility teacher or administrator.
Does the student miss an excessive amount of school? If so, see the counselor
for assistance. A plan needs to be developed to address this problem.
Have the parents been contacted? If so, document the contact and parent
response. If not, the parents must be contacted.
Has the student been assigned after-school tutoring? If so, did the student
and/or parents follow through? If not, see the counselor. Document student,
teacher, and/or parents’ actions.
Has a student/teacher conference been set up to discuss the problem? If so,
document the conference. If not, the teacher should set up a time to meet with
the student. Document the meetings.
Has the student been given time to make-up any missing assignments? If so,
document what has been done. If not, the teacher may want to ensure that
assignments are turned in and recorded. If the student is uncooperative this
should be documented.
*The student should attend meetings that address his concerns.
Harrison County School District
High School TST Recommendation Form
Tier I ____, Tier II____, Tier III ____
_____Passed Vision/Hearing Screening: Glasses Y/N; Hearing Aid Y/N
_____Failed Vision/Hearing Screening: Rescreen or refer for medical follow up
I. Physical Arrangements
A. _____Seat near the teacher
B. _____Avoid seating student near distracting areas or high traffic areas
C. _____Increase the distance between desks
II. Presentation of Subject Matter
A. _____Stand near student when giving directions or presenting a lesson
B. _____Check for student understanding of directions and concepts
C. _____Provide written outline/study guide/peer notes
A. _____Give extra time to complete assignments
B. _____Simplify complex directions
C. _____Provide a peer tutor to assist with assignments
D. _____Do not take off points for handwriting and spelling
E. _____Allow students to make up missing assignments
F. _____Other ____________________________________
IV. Test Taking
A. _____Different testing formats such as open book, oral, projects, etc.
B. _____Allow extended time for tests
C. _____Testing in quiet alternate setting
D. _____Allow student to request clarification of directions on all sections
E. _____Allow student opportunity to make up tests or retest if possible
A. _____Parent Conference _____Student Conference
B. _____Student Plan to improve absences, tardies, incomplete work,
motivation, or other
C._____ Referral to counselor/ social worker for behavior/other concerns
D. _____After school tutoring
E. _____Compensatory classes: ______________________________
F. _____Drop Out Prevention Program
VI. _____Tier III Needed (TST 7 must be filled out)
Harrison County School District
Steps in the High School TST Referral Process
1. Teacher submits referral request – TST 1
2. TST Chairperson schedules meeting with all of the student’s teachers.
3. _________ is given packet and is responsible for turning in forms to TST
Chairperson within 10 working days. Packet includes:
1. Tier I Documentation of Student Intervention/Strategies
2. Cumulative Student Profile for Secondary Level – teacher may request
assistance from counselor with this form. (TST 2A)
3. Statement of Confidentiality
4. _________ will keep a student folder with work samples.
*Additional paperwork including weekly progress monitoring is required for all
Tier III intensive interventions. Program reports, attendance/tardy reports, and/or
discipline summary reports may be used for Tier II progress monitoring.
TST Responsibilities: (TST meets within 2 weeks of date of referral.)
1. TST may invite parents to meeting for Tiers I or II. (Send TST Parent Letter.
*TST is required to invite parents to Tier III meetings. Although Tier I and Tier II
do not require parent/student invitation, it is a good practice to involve them.
2. TST meets, reviews documentation, consults with teacher(s), and makes
recommendations for Tier I or Tier II interventions.
3. Teacher(s) will be given the High School TST Intervention Recommendation
Form to implement interventions in Tier I or Tier II. Dates will be recorded on
TST 2A and TST 5 Meeting Summary Form. (TST 5 is a very important form for
4. TST will give copies of TST Intervention Recommendation Form to any other
involved faculty members and a copy will be filed in student’s TST folder.
5. Progress needs to be documented every 10 days for Tier II. Review and print out
student grades. Records from any of the computer based interventions should be
reviewed and copied. Work sample folder should be kept by teachers for
reference purposes. Progress monitoring for Tier I may be done on a
predetermined basis – less frequently than Tier II.
6. TST should meet after each reporting period. Changes may be made on the TST
Intervention Recommendation Forms and given to teacher(s). TST should
contact parents to notify them of their actions and clarify the team’s involvement
in the student’s academic progress – document ALL parental contacts. TST may
conduct classroom observations if needed.(TST 5 is needed for EVERY meeting.)
7. TST will make decisions regarding the effectiveness of the interventions. They
may decide that the interventions have been successful and are no longer
necessary, the interventions can be continued as part of regular Tier I teaching
strategies or Tier III may be recommended.
8. If Tier III is recommended, the TST will need to collect additional paperwork
and very intensive interventions will be required. For Tier III interventions, the
team will schedule a meeting inviting the parent/student and appropriate faculty
members. WEEKLY progress monitoring will be required. Tier III must be
completed within 18 weeks. Generally, secondary interventions will be made up
of two four and one half week interventions for a total of nine weeks due to the
secondary compressed schedule. (*Since secondary courses are on a compressed
schedule, 9 weeks will be the basic intervention period instead of 12 weeks.)
The following forms are required for Tier III if a referral is made for a
Comprehensive Evaluation: TST 1; TST 2A,B,C; TST 4A,B,C,D; TST 5;
TST 6; TST7; copies of Notice of Meeting Forms, and other appropriate
LSC forms.(*TST3 needs to be filled out it there are behavioral concerns.)
9. A student populated by the state on the MSIS screen must be referred to TST
within the first 20 days of school as MANDATED by state law. The MSIS screen
is updated every weekend by the state, and the TST is responsible for monitoring
the MSIS screen to add any new students. The TST Chairperson is responsible
for entering and maintaining MSIS data on these screens.
10. If a Tier III student is sent to the alternative school, Tier III interventions must be
continued at the alternative school. The student’s home school is responsible for
seeing that the interventions are in place, and they should request progress
monitoring from the alternative school on a predetermined schedule. Parents have
the right to request TST at any time.
11. MSIS Compliance reports are kept by the state to ensure adherence to state laws.
TST Chairpersons must monitor these compliance reports, provide a copy for the
principal’s TST binder, and send one to the appropriate district personnel.
Harrison County School District__________________________
Teacher Support Team
Notice of Meeting
Name of Student: _______________________________
Date Sent: ___________________________________
Dear Parent or Guardian:
Information regarding your child will be reviewed at a meeting of
the school’s Teacher Support Team (TST). The purpose of this meeting
is to determine if your child needs interventions designed to improve
your child’s school progress. This review will take place as indicated
Date of Meeting: ___________________________
Time of Meeting: ___________________________
Place of Meeting: ___________________________
You are invited to participate in this review and/or provide any
additional information you wish to have considered by the TST.
If you have any questions or concerns, please contact the
Name: _____________________________ Telephone: _______________
It is important to note that the “forms drive the process” in
implementing an effective Teacher Support Team.
TST 1 Request for Referral to the Teacher Support Team
TST 2A, 2B, 2C Cumulative Student Profile (2A specific to high school)
TST 3 Social/Emotional Issues Worksheet
TST 4A/4B TierI Documentation of Student Interventions/Strategies
Documentation Form (4A/4B specific to high school)
TST 4C Tier II and/or Data Chart
TST 4D Teacher Observation Form
TST 5 TST Meeting Summary Form
TST 6 TST Recommendations
TST 7 Tier III Instructional Documentation Sheet for Tier III
TST 8 Statement of Confidentiality
TST Parent Notification (Specific to High School)
TST Notice of Meeting – generic form
TST Ongoing Referral Log
REQUEST TO THE SCHOOL TEACHER SUPPORT TEAM
Student Name: _____________________________ Grade: _____ Date:_____________
Teacher: ________________________ School: _________________________________
Person Requesting Referral: ________________________________________________
TO: Teacher Support Team Chair
I request that the above named student be reviewed by the TST to assist in providing
interventions in an effort to improve his/her overall academic performance.
I have observed problems that interfere with his/her educational progress in the following
_____ Academic performance, low or failing grades
_____ Behavior and/or discipline
_____ Speech, articulation
_____ Other, specify ______________________________________________________
Referral of student is made based upon Mississippi State Board Policy IEI. These
referrals must be made within the first twenty (20) school days of a school year if the
child failed the preceding year. Please indicate below:
_____ Grades 1-3: Student has failed one grade.
_____ Grades 4-12: Student has failed two grades.
_____ Student failed either of the preceding two grades and has been suspended or
expelled for more than twenty (20) days in the current school year.
_____ Student scores at the Minimal level on any part of the Grade 3 or Grade 7 MCT.
TST member receiving request: ___________________________________________
Reason for Referral ____A
Current Grade Level:
Other High Schools Attended:
Date Entered 9th Grade:
Current Diploma Track:
Total Number of Credits Earned to Date:
Total Credits Needed:
Days Absent: 10th 12th
Vision Screening Date: Pass/Fail Pass/Fail Glasses: Y/N
Pass/Fail Hearing Aid:
Hearing Screening Date: Pass/Fail Y/N
TST Meeting Dates:
1st Semester 2nd Sem
Parent: Y/N Parent: Y
Math P1 P2 Sem P3
State Tests: Date; P=Passed; N/P=Not Passed; N/T=Not Taken
EngII__________ P/NP; AlgI__________ P/NP; BioI__________P/NP; US His__________P/NP
EngII__________ P/NP; AlgI__________ P/NP; BioI__________P/NP; US
EngII__________ P/NP; AlgI__________ P/NP; BioI__________P/NP; US
MCT: 7/8 grades
TST 2 B
Year Grade Read Lang Sci
C. ENVIRONMENTAL, CULTURAL OR ECONOMIC FACTORS-Check all factors that apply to the
student. Use available records, interviews with parents, and other resources to obtain data.
ENVIRONMENTAL CULTURAL ECONOMIC
___ Limited experiential ___ Limited experiences in ___ Residence in a depressed
background majority-bases culture economic area
(child does not participate
___ Irregular attendance in scouts, clubs, other ___ Low family income at
(absent at least 23% of the organizations and activities subsistence level
time in a grading period with members of dominant
for reasons other than culture) ___ Family unable to afford
verified personal illness) ___ enrichment materials
Child has limited and/or experiences
___ Transiency in elementary involvement in
school organizations and activities
___ of any culture
___ School readiness as
compared to peer group Secondary standards in
conflict with majority-
___ based culture standards
Are the above-checked items compelling enough to indicate this student’s educational
performance is primarily due to environmental, cultural or economic disadvantage?
ENGLISH LANGUAGE LEARNER
How long has the student spoken
Is there a language other than English spoken by the student? Yes No
Is there a language other than English spoken in this student’s home? Yes No
(If the above information indicated the student has not always had English as their primary language, please address the following
What ELL services or assistance have been provided?
Do the results of evaluation by the ELL teacher indicate lack of expected progress in the English language
for the student’s chronological age level? Yes No ( If not, explain)
8-18-08 What is the student’s current proficiency in English ? _____________________________
(Keep in mind that conversational language skills are not the same as the ability to think and reason in a
language. While the student may be able to speak with peers or adults and to understand basic instructions
or rules, the effects of ELL may still affect the student’s ability to think and reason academically.)
Does the student experience any motor limitations, which impact educational performance? If yes, explain
further with summary of parent and medical
Students should not be classified as having a learning disability if failure to progress academically is due to
an absence of motivation. To help clarify if motivational issues are the primary cause of the student’s
academic deficits, please address the following questions:
Does the student want to succeed in school? Give examples to support your answer.
Does the student seek assistance from teachers, peers, others?
Does the parent report efforts made at home to complete homework or study assignments?
Is the student making an effort to learn? Explain.
Are student’s achievement scores consistent with the student’s grades?
Situational stressors can cause daydreaming, poor memory, lack of attention, etc. which affect educational
performance. Temporary, sudden, or recent change in the student’s life must be ruled out as a primary
cause of academic deficits.
Has the student experienced a recent trauma? (i.e. parents divorced, illness of student or family member,
death of family member or serious accident or injury, financial crisis, crime victim,
Is there any other situation that could create stress or emotional upsets?
Has there been a significant change in the student’s classroom performance within a short period of time
Signature of Classroom Teacher Date
School-based Instructional Personnel Date
Social/Emotional Issues Worksheet
Student ____________________________ Grade ____ Date _______
(PLEASE COMPLETE THE FORM TO THE BEST OF YOUR ABILITY. PLEASE GIVE FACTUAL RATHER THAN OPINION-
STUDENT IS DISRUPTIVE IN CLASS:
is overly active
will not remain in seat
talks out of turn
disturbs others when they are working
constantly seeks attention
overly aggressive with others (i.e., physical fights)
belligerent toward teachers and others in authority
defiant or stubborn
can’t wait his/her turn
acts without thinking of the consequences
STUDENT IS WITHDRAWN
has difficulty making friends
sits alone in cafeteria
does not join in classroom group activities
overly conforms to rules
appears to daydream or be out of touch with the class
has difficulty expressing feelings
STUDENT IS ANXIOUS:
appears to be tense
appears frightened or worried
does not trust others
reports fears or phobias (such as fear of coming to school)
OTHER SOCIAL/EMOTIONAL BEHAVIORS:
says “can’t do” even before attempting
reacts poorly to disappointment
TST 3 is overly sensitive to disappointment
8-18-08 depends on others
clingy with adults
pretends to be ill
has poor grooming or personal hygiene
been on runaway status
been caught for stealing at school
left class without permission
cursed school personnel
threatened to harm school personnel or wished school personnel harm
been suspended for fighting
had tobacco violations at school
had drug/alcohol violations at school
High Mild Bored Other, Please Specify
always brings necessary supplies
usually brings supplies
seldom comes to class with supplies
never comes to class with supplies
tends to give up easily
usually completes about half of the assignment
does complete homework
has difficulty getting started on assignments
TO THE BEST OF YOUR KNOWLEDGE:
This student is involved with the court system.
This student is in counseling.
This student is on medication.
Student ____________________________ Subject Area _______ Grade __________
Tier One Documentation of Student Interventions/ Strategies
Alternative strategies and interventions for improvement of the student’s reading skills
have been implemented and the student has not made progress. (Documentation of
student performance must be provided.)
Strategies/Interventions Results Dates (To/From)
Interventions for Tier One may include:
Explicit and systematic small group instruction within the regular classroom
Instruction that has been broken down into manageable steps
Instruction has been provided using a different teaching strategy
Instruction was provided using a different response mechanism.
Student has been provided with additional practice activities.
Student has been provided with immediate and specific feedback.
* General ed teacher observation will be needed for documentation.
Tier II Documentation Form
Student _________________________Subject Area _______ Grade_____
Target Academic Area(s):_____________________________
Proposed Schedule (i.e. number of sessions per week, length of each session, where
intervention will take
Integrity of Intervention will be observed by _______________________
during ___________ number of sessions.
Student’s parents notified of Tier II intervention (circle): Y / N
TST Committee will review Tier II intervention data on ___________________.
* 2 observations required during Tier II.
TIER II AND TIER III DATA CHART
Student Name __________________________________ ___ Reading
School _______________________ Grade ___________
What is the supplemental instruction? ______________________ ___ Other
Week # Date CBM Week # Date CBM Week # Date CBM
Data Data Data
Baseline Supplemental Instruction
B1 B2 B3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Dependent Variable: ________________________ Put numbers in the blanks on the left of the graph to indicate if it is
percentage 10, 20, 30 or WCPM: 10, 20, 30, 40 or 1, 2, 3, 4 writing rubric.
Teacher Observation Form
Student Name: _______________________ Grade: _______Tier_______ Date: ___________________
Teacher Name: _______________________ Observer: ________________________________________
Principal signature to ensure fidelity of instruction:__________________________________________
Document of Teacher Observation for Interventions
Observations Appropriate Instruction Differentiated Instruction Appropriat
Conducted Being used? Manag
Mathematics Y N Y N Y N Y
(Appropriate reading instruction
includes: explicit/systematic instruction Y N Y N Y N Y
in the essential components of reading:
PA,Phonics, Vocab, Fluency, Comp)
Language Arts Y N Y N Y N Y
Teacher Support Team (TST) Meeting Summary Form
Student: ___________________________ Birthdate: ___/___/___ Age:__________
School: ___________________________________________Grade: __________
Meeting Date: _______________________
Summary of Discussion: _________________________________________________________________
( ) Parental Contact ( ) Additional Screening (5 yr. old, in-school)
( ) Hearing/Vision Screening
( ) Academic Instructional Intervention in the
( ) Medical Follow-up
area(s): ___Reading___Math ___Language
Other ____________________ ( ) Referral to School Counselor
( ) Referral to Community Agency
( ) Behavior Management Program/Plan
( ) Remain in Regular Education
( ) Behavior Observation
( ) Continue Instructional Intervention(s) in
( ) Student Conference Regular Education Classroom
( ) Complete Teacher Narrative Packet
( ) Other:
( ) Refer for Child Study (LSC Chairperson
will notify you of upcoming meeting)
Tier I ____ Tier II____ Tier III ___
( ) Other:
TST Members Present:
The students and subjects discussed in this meeting are CONFIDENTIAL. This meeting is being
conducted and data collected for use only for the purpose of identifying possible achievement and/or
social-behavioral problems. These forms and all supporting data are to be kept in a secure place.
You will need to look in your TST Binder for the rest of the
forms. I could not copy the form in the correct format to this