1 Trevor Rolfe is a 16-year-old sophomore student who attends Clay Local High School. Trevor has severe hearing loss, but uses hearing aids. His parents taught him sign language at a young age. Trevor also has 4/20 vision, but it is corrected when he is wearing glasses. Trevor has dyslexia, a minor learning disability, which inhibits him from completing the curriculum on his own, unlike his nondisabled peers. He is in an all- inclusive classroom but because of his dyslexia he has an aid, which reads to him because he mixes up his letters and words, numbers, and signs. When Trevor was about four months old, his parents noticed that he did not respond to them when they walked in the room. He was not startled by loud noises and did not seem to recognize when little things happened around him. Trevor’s parents took him to a hearing specialist to discover what was wrong with him. Trevor was identified with vision loss at age two. When watching TV, he had to sit really close to the television and had trouble playing with different toys. He often forgot where he put things because he could not see them. They went to an eye specialist and they tested him with the 2 clinical low-vision assessment, which recommended that would benefit from optical lenses. Trevor says he wants to follow in his father’s footsteps and become the Technology Coordinator at Clay High. Trevor took the OAA in 8 th grade and got a proficient in Reading scoring a 402 and a proficient (but low) Math score of 400. Since he is in 10 th grade, he will be given a Career Assessment along with an Interest Survey administered by Career Specialists to determine what he is interested in. These tests will help Trevor’s parents and educators make appropriate decisions when planning his postsecondary education. Trevor will also take the OGT, or the Ohio Graduation Test, at the end of his sophomore year so he can graduate and attend college. Trevor will take the ACT when he is a junior in hope to receive a composite score of 21. While Trevor suffers from some impairments, he does well in school. Trevor’s favorite subject is Math, but it does not come easy to him. Because of his dyslexia, he struggles with mixing up numbers and letters, making it hard for him to correctly copy down problems and formulas. This is especially challenging for him in Geometry because there are so many formulas that he has to memorize. He has no trouble memorizing the formulas, but when he tries to write them down he gets mixed up. However, he loves solving equations and is able to answer some upper level math problems. Trevor’s other main weakness is reading because of his dyslexia. He struggles with reading and writing. Trevor mixes up words and spells some things backwards making his work similar to cracking a code. However, he is determined to increase his reading level and works very hard to improve. The KWL-IG ...

1. 1
Trevor Rolfe is a 16-year-old sophomore student who attends
Clay Local High
School. Trevor has severe hearing loss, but uses hearing aids.
His parents taught him sign
language at a young age. Trevor also has 4/20 vision, but it is
corrected when he is
wearing glasses. Trevor has dyslexia, a minor learning
disability, which inhibits him from
completing the curriculum on his own, unlike his nondisabled
peers. He is in an all-
inclusive classroom but because of his dyslexia he has an aid,
which reads to him because
he mixes up his letters and words, numbers, and signs.
When Trevor was about four months old, his parents noticed

2. that he did not
respond to them when they walked in the room. He was not
startled by loud noises and
did not seem to recognize when little things happened around
him. Trevor’s parents took
him to a hearing specialist to discover what was wrong with
him. Trevor was identified
with vision loss at age two. When watching TV, he had to sit
really close to the television
and had trouble playing with different toys. He often forgot
where he put things because
he could not see them. They went to an eye specialist and they
tested him with the
2
clinical low-vision assessment, which recommended that would
benefit from optical
lenses.
Trevor says he wants to follow in his father’s footsteps and
become the
Technology Coordinator at Clay High. Trevor took the OAA in
8
th

3. grade and got a
proficient in Reading scoring a 402 and a proficient (but low)
Math score of 400. Since
he is in 10
th
grade, he will be given a Career Assessment along with an
Interest Survey
administered by Career Specialists to determine what he is
interested in. These tests will
help Trevor’s parents and educators make appropriate decisions
when planning his
postsecondary education. Trevor will also take the OGT, or the
Ohio Graduation Test, at
the end of his sophomore year so he can graduate and attend
college. Trevor will take the
ACT when he is a junior in hope to receive a composite score of
21.
While Trevor suffers from some impairments, he does well in
school. Trevor’s
favorite subject is Math, but it does not come easy to him.
Because of his dyslexia, he
struggles with mixing up numbers and letters, making it hard for
him to correctly copy
down problems and formulas. This is especially challenging for

4. him in Geometry because
there are so many formulas that he has to memorize. He has no
trouble memorizing the
formulas, but when he tries to write them down he gets mixed
up. However, he loves
solving equations and is able to answer some upper level math
problems.
Trevor’s other main weakness is reading because of his
dyslexia. He struggles
with reading and writing. Trevor mixes up words and spells
some things backwards
making his work similar to cracking a code. However, he is
determined to increase his
reading level and works very hard to improve.
The KWL-IG Assessment, Administration, Analysis
(Prescriptive-Diagnostic), and Intervention Form
Student Name Your Name:
Course: Date:
Assessment, Administration, Analysis (Diagnosis), and
Intervention/Instruction Response
What do you know? (K)
List all the facts about the student. List inferences and tie them
to the corresponding facts.

5. What do you want to know? (W)
List additional data that you need for the next step in your
diagnosis. Beside each data you need, note the data collection
source/instrument and method you would use to gather the
relevant information.
What have you learned? (L)
Based on the corresponding fact, state what you have learned
about the student. List the student’s strengths and weaknesses
clearly.
What have you learned from the assessment you administered?
What intervention/instruction will you use to meet student’s
needs? (I)
Select any evidence-based intervention that you would use to
meet the student’s needs.
Use the ABC guide below to complete this column.
What is/are your long-term/short-term goal(s)? (G)
Develop goals based on your student’s needs.
Ex. A-1. Student reads at 4.6 grade level (WJ III)
Ex. W-1. What is student’s fluency level? (DIBELS ORF)
Ex. Areas of weakness: Given an ORF assessment, student reads
85 CWPM. Nondisabled peers reading fluency range 134-155
CWPM.
Areas of strength: Student’s comprehension skills are not as low
as would be expected. She uses context clues and picture clues
to aid with comprehension.
Ex. Assessment-based learning objectives: Student will increase
fluency to 115 CWPM by the end of the fall semester.
Specific diagnostically-based strategy: The student will be
instructed using Repeated reading three times a week for 30
minutes.
Learning objective-based assessment: Student rate of progress
will be assessed using Running Records
Ex. By the end of the fall semester, given instruction using
Repeated Reading, Jane will increase her fluency by reading
115 CWPM self correcting 75% of the time as assessed by a

6. Running Record.
Inferences:
Inferences:
Inferences:
Ex. A-1. Student will struggle to read grade 11 material.
Ex. Fluency will impact comprehension because student will
focus on word formation and not overall meaning of passage.
Ex. Student has not developed automaticity with basic sight
words. Fluency (automaticity) would free the student’s ability
to focus on meaning of text.

7. Go to section I after completing the first three columns. Use the
instructions below to complete section I. Be sure to link facts
and inferences using letter and/or numbers.
A. Develop assessment-based learning objectives for each row.
B. State a specific diagnostically-based strategy for each
learning objective (be able to support this choice)
C. State the learning objective-based assessment you will use to
assess student outcome (for your learning objective, be able to
show a link between the skills needed in learning the objective
and the skill needed to accurately reflect the level/degree of
student learning).
Lastly write an annual goal in section G for each area of need
identified.
Important: All descriptions in color are examples to assist you
in completing this form. They are NOT to be used in your final
project!
Rubric for KWL-IG Form and Narrative
Content
Expected score
Actual score
Comments

8. Narrative: Detailed description of student. Briefly describe the
classroom setting ( 250-400 word).
15
K-Write brief/important factual information about the student.
The information should be based on student’s IEP (Present
level, of performance, current placement, current
accommodations, etc.), teacher information, parent information
or case study information.
15
W-Describe what you want to know and how you will obtain
that information. Justify the importance of that information and
list the data collection source(s)/instrument(s) and method(s)
you would use to gather the relevant information.
15
L- Describe what you learned from the background information
and your assessment(s). Link the facts, inferences and what you
have learned to describe what you now know. Describe the
student’s strengths and weaknesses.
15
I- Develop an assessment-based learning objectives for each
row.
State a specific diagnostically-based strategy for each learning
objective (be able to support this choice)
State the learning objective-based assessment you will use to
assess student outcome
15

9. G- Write long-term and/or short-term objectives in measurable
terms (As would be written in an IEP)
15
Mechanics and APA format.
10
Total
100