1. SAT Checklist
Pre-referral Documentation (must be completed and submitted prior to initial SAT meeting):
_____ Tier I Interventions
_____ Tier II Interventions
_____ Other documentation forms as necessary.
_____________________________________________________________________________
Initial SAT Meeting
Date: _______________
_____ Vision/Hearing Screening completed prior to meeting
Passed Vision: Yes No Passed Hearing: Yes No
_____ Teacher Observation Form
_____ Special Area Observation Form
___ Art ___ Music ___ PE ___ Speech
___ Reading ___ ESOL ___ SPECTRA ___ Other
_____ Tier III
_____ Other documentation forms as necessary.
Action taken: ___ Continue Interventions ___ Modify Interventions ___ Exit from SAT
Follow-up SAT Meeting
Date: _______________
_____ Tier III Updated
_____ Other documentation forms as necessary.
Action taken: ___ Continue Interventions ___ Modify Interventions
___ Refer to EC ___ Exit from SAT
Follow-up SAT Meeting 2
Date: _______________
_____ Tier III Updated
_____ Other documentation forms as necessary.
Action taken: ___ Continue Interventions ___ Modify Interventions
___ Refer to EC ___ Exit from SAT
EC Referral
