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Marysville Joint Unified School District SECONDARY REFERRAL CHECKLIST FOR CATCH UP INTERVENTION PLAN Individual Learning Plan (ILP) Student Name: Date: To: From: Please take a few minutes to complete

How to fill out secondary prereferral checklist

How to Fill Out a Secondary Prereferral Checklist

1. Begin by gathering all relevant information about the student in question. This includes their academic records, behavior reports, and any previous evaluations or interventions.
2. Review the purpose of the secondary prereferral checklist, which is to identify and assess the specific needs of a student who may require additional support or interventions.
3. Familiarize yourself with the sections of the checklist. These typically include sections for demographic information, academic performance, behavior and social-emotional development, and any additional concerns or observations.
4. Fill out the demographic information section accurately, ensuring that all details such as the student's name, grade level, and date of birth are correctly recorded.
5. Move on to documenting the student's academic performance. This may involve indicating their current performance levels in specific subjects, any standardized test scores, and any concerns or observations related to their academic progress.
6. Progress to the behavior and social-emotional development section. Here, note any behavioral challenges or strengths the student exhibits, as well as any observations regarding their social skills, self-regulation, and overall emotional well-being.
7. Take the time to thoroughly assess any additional concerns or observations that are not covered in the other sections. This could include information about the student's home environment, medical history, or any other factors that may be influencing their educational experience.
8. Carefully review all the information you have provided in the checklist, ensuring that it is accurate and complete. Make sure there are no critical details or observations that have been overlooked.

Who Needs a Secondary Prereferral Checklist?

1. Teachers or educators: They may need a secondary prereferral checklist to identify students who may benefit from additional support or interventions in the classroom.
2. School administrators: They may use the secondary prereferral checklist to identify students who require further evaluation or to determine the appropriate interventions and resources needed to meet their educational needs.
3. Special education teams: These teams may use the secondary prereferral checklist as a tool to gather comprehensive information about a student before considering a referral for special education services.
4. Student support personnel: School counselors, psychologists, or social workers can use the secondary prereferral checklist to guide their assessment and interventions for students who may require additional support in their socio-emotional development.

In summary, filling out a secondary prereferral checklist involves gathering student information, completing the checklist sections, and reviewing the information provided to ensure accuracy. This checklist is useful for teachers, administrators, special education teams, and student support personnel when identifying and addressing students' unique needs.

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