Las Cruces Public Schools Student Assistance Team (SAT) Meeting Summary Worksheet
Student’s Name: ____________________________ Grade: __________ Date of Meeting: ________ School: ____________________ Teacher/Team: _______________ Referred by: SAT Team Attendee (Print Name) SAT Chairperson: Parent/Guardian: Parent/Guardian: Teacher: Teacher: PART I Review All Factors That Apply: Speech Language General Physical Health Mental Health/Behavioral Concerns Attitude Toward Self Academic Progress for Grade Level (Reading) Academic Progress for Grade Level (Written Language) Academic Progress for Grade Level (Math) School Attendance Evidence of Lack of Instruction Signature Type of Meeting:
□Teacher/Team
□ Initial □ Follow up □ Parent/Guardian □ Other: ___________
Signature
SAT Team Attendee (Print Name) Administrator: Counselor: Related Service:
Describe ANY Impact on Learning:
□ Normal □ Receptive
Difficulties impaired
□ Rapid □ Expressive □ Chronic
illness Difficulties
□ Slow or
Slurred
□ Degree of
Unintelligibility
□ Normal □ Good □ Excellent
Abuse
□ Fragile or □ Conduct □ Poor
□ Anxiety □ Normal/
Positive
□ Depression □ Substance □ Confident □ Overly
Confident or Unrealistic
□ Significantly □ Below
Below
□ At Grade
Level
□ Above □ Above □ Above □ Good to
Excellent
□ Significantly □ Below
Below
□ At Grade
Level
□ Significantly □ Below
Below
□ At Grade
Level
□ Poor/Truant □ Tardy □ No
Schooling
□ Frequent
Moves instruction
□ Periods of
nonattendance
□ Ineffective □ No Concern
Factors Continued Attention/Interest in School Impulse Control School/Social Relationships Relationship with Teacher Learning Style Classroom Environment
Describe ANY Impact on Learning:
□ Poor or □ Poor □ Poor
Indifferent
□ Distracted or □ Alert &
Bored
Engaged
□ Over-
responsive
□ Fair □ Fair □ Normal
□ Good □ Good □ Requires
Frequent Contact
□ Excellent □ Excellent □ Requires
Excessive contact
□ Distant or
Reluctant
□ Visual □ Auditory □ Unstructured □ Structured
□ Kinesthetic □ Combination □ Highly □ Combination
Structured
PART II Describe the Student’s Strengths: _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ PART III Cultural Background/Language Information: a.) Describe any relevant cultural background/experience: _____________________________________________________________________________________________ b.) Languages spoken: ________________________ ________________________________ ________________________________ c.) Language proficiency screening results (include LCPS Vision/Hearing Screen results: ___________________________________________________________________ PART IV Summary of Screening and Recent Test Results (including LCPS Vision and Hearing Screen): ______________________________________________________ _____________________________________________________________________________________________________________________________ __________________________ PART V (FOR GIFTED CONSIDERATION ONLY): Has the SAT determined any factors (i.e., socio-economic, cultural/Linguistic, and/or disability) that might affect the student’s performance on a traditional standardized test?
□ No □ If yes, what factor(s)?_________________________________________________ (F-TAP evaluation is required if proceeding to a gifted evaluation.)
PART VI Describe Intervention(s) Attempted and Their Effectiveness: (Describe each intervention and rate its effectiveness 1-5, with 1 as the least effective.)
Intervention(s): √ if Classroom √ if Home Rating
PART VII SAT Determination: (Based on input examined by the SAT, note the next steps decided upon for this student.)
□ The student appears to need no further intervention at this time: □ NO further action required, or □ Monitor and follow up required by (date): ______ □ The student’s needs suggest that an SAT Intervention Plan is warranted (Reference and complete LCPS SAT Intervention Plan) □ Existing data is insufficient for a complete determination. More information is required. The SAT will reconvene on (date): ___________________