Georgia's CEIS Documentation Form FY13

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					                   Georgia’s Coordinated Early Intervening Services (CEIS)
                                 FY13 Documentation Form


District: ______________________
Contact Person: _________________          Phone: _____________         Email: ____________

 Directions: The district should complete a CEIS Documentation Form for each intervention.

 Check the Area(s) of Disproportionality

      Identification             Placement                 Discipline

 1. Explicitly describe the district-level data used to identify the need for the CEIS such as CRCT,
    universal screening data, suspension data, attendance data, and Disproportionality Self-Assessment
    Comprehensive Data Analysis Sheet. Describe any available trend data.




 2. Provide a descriptor of the intervention and how the early intervening service will support the
    targeted group of students. The descriptor must also address professional development, personnel,
    and software that are allocated in the CEIS budget, as well.




 3. Discuss the examination of studies and/or research to support the intervention or activity.




                                     Georgia Department of Education
                              Dr. John D. Barge, State School Superintendent
                                               March 2012
                                                     1
                   Georgia’s Coordinated Early Intervening Services (CEIS)
                                 FY13 Documentation Form


4. Who is the targeted audience for the CEIS? How does the intervention meet the diverse needs of the
   at-risk students (e.g., linguistically, socioeconomically, and culturally, etc.)?

    Note: The CEIS shall be provided to students in K-12 who are not currently identified as needing
    special education or related services, but who need additional academic and behavioral supports to
    succeed in a general environment.




          a. Targeted School(s)




          b.   Targeted Grade Level(s)




5. Describe the entrance and exit tool (s) and criteria used to identify students for CEIS (i.e. universal
   screener, CRCT, EOCT, etc.).

    Note: Each school may identify entrance/exit criteria appropriate for its services and
    demographics. The process should allow students to exit at anytime.




                                     Georgia Department of Education
                              Dr. John D. Barge, State School Superintendent
                                               March 2012
                                                     2
                     Georgia’s Coordinated Early Intervening Services (CEIS)
                                   FY13 Documentation Form


6. Describe the ongoing progress monitoring procedures that will be used to measure student outcomes.

    Note: Progress monitoring procedures should provide frequent data collections, a minimum of once a
    month, at consistent intervals to support at-risk students in meeting individualized goals.




7. Briefly describe the plan to monitor and assess fidelity of implementation at the district level?

    Note: Who will monitor the CEIS for fidelity? What are the monitoring procedures?




8. How will the district evaluate the effectiveness of the CEIS? What kinds of formative and
   summative data will your district review to determine program effectiveness?

     Note: The GaDOE must track students who have exited CEIS and determine if those students
     become eligible for special education services within two years.




                                       Georgia Department of Education
                                Dr. John D. Barge, State School Superintendent
                                                 March 2012
                                                       3
                     Georgia’s Coordinated Early Intervening Services (CEIS)
                                   FY13 Documentation Form


                                                 FY12 Budget
1. What is the allotted amount of funds for CEIS?
Note: All districts determined to have significant disproportionality (SD) must use 15% of their federal
funds to provide CEIS. Districts not determined to have SD may opt to use up to 15%.

2. Are there carryover funds (CEIS) from the previous school year? If appropriate, how much carryover
funds?


3. What is the proposed number of students that will receive CEIS?
Note: The district shall ensure that the proposed number of students is commensurate with the allotted
amount of funds. For example, $100,000 used to provide services for 10 students may not be an
appropriate choice.


4. The district shall use Table 1 (CEIS Budget Form) to list individual expenditures outlined in the CEIS
plan. The district shall identify the funding category, type of fund, brief descriptor, and fiscal allotment.
Expenditures should clearly outline appropriate information.

A. Funding Category: The funding categories typically used for CEIS are listed below Table 1

B. Type of Service: The district shall identify expenditures as professional development or educational
and behavioral evaluations, services, and supports. Professional development activities must be aligned
to a targeted group of students!

C. Brief Explanation of Expenditure: The district shall identify each resource listed in the CEIS plan that
requires use of these funds. Descriptors must include adequate information to review each request (e.g.,
number of days for professional development, number of teachers receiving training, number of personnel
hired to provide a service; fulltime or part-time work status, breakdown of salary and benefits, number of
student licenses, etc.).




                                       Georgia Department of Education
                                Dr. John D. Barge, State School Superintendent
                                                 March 2012
                                                       4
                     Georgia’s Coordinated Early Intervening Services (CEIS)
                                   FY13 Documentation Form


Table 1. CEIS Budget Form

Funding Category                 Type of Fund               Brief Explanation of              Amount
                                                                Expenditure




Total Expenditures

Funding Categories
1000 Series- Instruction includes activities dealing directly with the interaction of teachers and students.
2100 Series - Pupil Services deal directly with activities designed to assess and improve the well-being of
students and to supplement the teaching process.
2210 Series - Improvement of Instructional Services include activities which are designed primarily for
assisting instructional staff in planning, developing, and evaluating the process of providing challenging
learning experiences for students

                                       Georgia Department of Education
                                Dr. John D. Barge, State School Superintendent
                                                 March 2012
                                                       5
                 Georgia’s Coordinated Early Intervening Services (CEIS)
                               FY13 Documentation Form


Resources



      http://archives.gadoe.org/DMGetDocument.aspx/Intervention.Review.Protocol.SERVE_
       Center.pdf?p=6CC6799F8C1371F650CE201D1835849EF89FC6202B0F4FDBD34E84E
       3E37ECA0B&Type

      http://www.rti4success.org/progressMonitoringTools




                                  Georgia Department of Education
                           Dr. John D. Barge, State School Superintendent
                                            March 2012
                                                  6

				
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