Fillable Wyoming Individual Reading Plan (State of Wyoming)

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Wyoming Individual Reading Plan (State of Wyoming)

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Student Name: _______________________ Individual Reading Plan
This form was adapted from the Mississippi D
epartment of Education Individual Reading Plan (IRP) documentation packet.
Page1
Wyoming Individual Reading Plan
Student Name:
Teacher/School:
Date:
Individual Reading Plan
Students not reading at grade level or not meeting screening or assessment
benchmarks shall be placed on an individualized reading plan. That includes, at a
minimum, the following:
Section A: Determining Reading Skill Gaps:
• The student's specific reading skill deficiencies identified by screening and diagnostic
assessment data. Screening identifies possible skill deficits. Diagnostic data provides
detailed information about those skills deficits that can be used to group students and
inform instruction.
Section B: Core Reading Instructional
• The evidence-based core curriculum and intervention teacher(s) will use to provide
reading instruction and intervention support.
Section C: Instructional Services and Interventions
• What are the target deficit areas?
• Which evidence-based program will be used to fill specific skill gaps? Training teachers
have received in evidence-based core or intervention programs.
• Whether the student will be receiving Tier 2 or Tier 3 instructional supports. Who will be
providing the supports, and with what frequency?
Section D: Goals and Benchmarks for Growth
Section E: Progress Monitoring and Review
Section F: Parent/Caregiver Consultation
Section G: Additional Services
Student Name: _______________________ Individual Reading Plan
This form was adapted from the Mississippi D
epartment of Education Individual Reading Plan (IRP) documentation packet.
Page2
Section A: Determining Reading Deficiencies
Student Name:
Grade:
School:
District:
Teacher:
Gender:
Phone:
Email:
Street Address:
Screening Instrument:___________________
*
W.S. § 21-3-401 requires that these skills are screened. The evidence-based screener your district
selects may screen a variety of subcategories of these skills and or additional skills such as Vocabulary or
RAN. Screening 3x a year is recommended for all students.
Skill
1
st
Screening Date:_______
2
nd
Screening Date:_______
3
rd
Screening Date:_______
*Phonological Awareness
*Phonics
*Real words and Nonwords
* Oral Reading Fluency
* Comprehension
Diagnostic Data
Diagnostic Data
Diagnostic Data
Attendance
School Year Days Present/Absent
_________ _______ / ______
_________ _______ / ______
_________ _______ / ______
Not
e: Attach suspension data if
applicable
Retention
Instructions: If applicable, indicate
grade(s) and school year(s) below.
Gr
ade School Year
_______ ____
______
Special Population
Instructions: Check if applicable to
student.
☐ Special Education / IEP
Initial Eligibility Date: ________
Eligibility Category: ________
☐504
☐ELL (Appendix B)
☐Dyslexia
☐
Other _____________________
K-3 WY-TOPP
Date
Lang. Arts
Math
BOY
MOY
EOY
Course Performance
Subject
Q1
Q2
Q3
Q4
Reading
Math
Sci
Soc. Studies
Writing
Student Name: _______________________ Individual Reading Plan
This form was adapted from the Mississippi D
epartment of Education Individual Reading Plan (IRP) documentation packet.
Page3
Section B: Core Reading Instructional Program
What evidence-based program are being used to deliver explicit, systematic core
reading instruction during the 90-minute reading block?
Training general education teachers have received in core reading program:
Does the core reading program provide:
Guidance about explicit instruction Yes ___ No __
A
clear scope and sequence Yes ___ No __
A
pacing guide Yes ___ No __
Sufficient initial and distributed practice materials Yes ___ No __
Rese
arch data demonstrating that the program is valid and reliable? Yes ___ No ___
Indicate the areas addressed by the core reading program:
☐ Phonol
ogical Awareness
☐ Phonics
☐ Fluency
☐ Vocabulary
☐ Comprehension
Indicate additional supplemental materials or programs that are used.
Student Name: _______________________ Individual Reading Plan
This form was adapted from the Mississippi D
epartment of Education Individual Reading Plan (IRP) documentation packet.
Page4
Section C: Instructional Services and Interventions
Instructions: Classroom teachers, interventionists and special education teachers should
work together to complete this form for each student identified as needing an Individual
Reading Plan based on reading deficiencies.
Target Deficit Area (can be more than one):
______Phonological _______Phonics _______Fluency
______Voc
abulary _______Comprehension
List evidence-based core or intervention program that will be used to address specific
skill gaps:
Who will provide instructional
support?
List Tier and frequency of support
Tier 2 __ Frequency Days per week __________
Tier 3 __ Minutes per day __________
List specific training teacher implementing instructional support has attended:
Se
ction D: Goals and Benchmarks for Growth
Instructions: Teachers should complete progress monitoring for interventions. It is recommended that
the teacher establish a baseline by administering three (3) probes or trials, selecting the median, and
marking the baseline by placing a dot on the vertical axis. Teachers should determine the goal by
determining the expected rate of progress and marking the target by placing a dot at the intersections.
On the bolded line above each month, indicate the first result recorded that month; on the line to the
right, indicate the second result of that month.
Name of Progress Monitor:
Baseline______________ Goal______________
Student Name: _______________________ Individual Reading Plan
This form was adapted from the Mississippi D
epartment of Education Individual Reading Plan (IRP) documentation packet.
Page5
Section E: Progress Monitoring
Intervention Start Date:_________________
How will progress be monitored and evaluated?
1
st
Documented Review Date:_________
(to be completed no later than 8 weeks after
starting intervention)
Sufficient Progress Made? Yes / No
(if no, an additional intervention form should be
completed)
Cumulative Document Review Date:_____
(to be completed no later than 16 weeks after
starting intervention)
Sufficient Progress Made? Yes / No
(if no, an additional intervention form should be
completed)
☐ Adequate progress
was made; intervention
wa
s successful in
meeting student’s needs.
This student will be
returned to the
following tier:
☐ Tier I
☐ T
ier II
Re-eval
uation date: ____
☐ Adequate progress
was not made;
intervention was
somewhat successful
in meeting student’s
needs. Student will
continue at Tier III and
additional intervention
will be attempted.
☐ Adequate
progress was not
made; intervention
was not successful in
meeting student’s
needs. Referral to
Tier 3 on (date):
☐ Student currently
has an IEP. Complete
the information in the
area below.
En
ter Eligibility
Category
Student Name: _______________________ Individual Reading Plan
This form was adapted from the Mississippi D
epartment of Education Individual Reading Plan (IRP) documentation packet.
Page6
Section F: Parental Support
Target Deficit Area (can be more than one):
______Phonol
ogical _______Phonics _______Fluency
______Vocabulary _______Comprehension
The following strategies are recommended for parents/families to use in assisting the student
to achieve reading competency:
Readi
ng to students at home, audio-books
Parent Conference
Date:______________
Recor
d of topics discussed:
Written Parental Notification Received:
Par
ent Signature:_____________________________ Date:______________
Section G: Additional Services
Indicate any additional services the teacher deems available and appropriate to accelerate the
student’s reading skill development, if applicable:
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Wyoming Individual Reading Plan (State of Wyoming)

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Completed 5 February 2022

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