This document outlines a tiered/universal design lesson plan template that incorporates instruction for all students (Tier 1), targeted and temporary instruction for students who need more support (Tier 2), and intensive individualized instruction (Tier 3). The template includes sections to describe instruction, materials, assessments, and data-driven decisions for each tier. Tier 1 involves whole group instruction addressing standards. Tier 2 involves small group instruction to meet specific skill deficits. Tier 3 involves individualized instruction for students who need intensive support to acquire skills. Progress is systematically monitored and instruction is modified based on student response and data analysis at all tiers.

1. Tiered/Universal Design Lesson Plan Template
Classroom ________________________________ Date ______________
Tier 1 General or Universal instruction for all Learners
Activity: ____________________________ Standard Addressed: _________________________________________
Goal/Outcome of lesson: (use terms like express, receive, show, solve, select, generate etc. to allow access to learning by all students)
__________________________________________________________________________________________________
Evidence Based Instructional Guide Used. Include lesson or page number (ex. Houghton Mifflin, Kid Writing,
Everyday Mathematics, etc.):
__________________________________________________________________________________________________________
Description of how Activity/Instruction/Lesson will be taught through multiple ways of Representation: during
Whole Group/small group/guided reading/small group math/workshop group. List materials that will be used.
Visual/Verbal and Auditory: i.e. orally Kinesthetic/Tactile: Affective: Technology
non verbal: state/chant or sing I.e. demonstrations, sign I.e. role playing, options:
I.e. use charts, graphs, directions, sing songs with language or gestures, connecting to student I.e. Overhead projector,
pictures, watch video content, read aloud hands on manipulatives. interest areas, cross age ELMO, books on tape or
clips or photographic books. peer tutoring. computer.
slideshow.
Adaptations/accommodations/modifications that are needed:
___________________________________________________________________________________________________________
Description of how children will be able to practice skill and meet outcomes of the lesson through multiple
ways of Engagement: Workshops/Small group/Individual Center Activities for acquisition of skill. List materials.
Visual/Verbal and Auditory: Kinesthetic/Tactile: Affective: Technology
non verbal: I.e. listen to text / content I.e. use a game format, I.e. work in small groups, options:
I.e. draw/illustrate/write read or sung aloud, listen build a model, use pieces with a partner or alone, I.e. use computer
idea/concept on paper, to/ retell directions or or objects to sequence, build student interest and software or interactive
design a poster/chart, steps of lesson, oral Q&A provide manipulatives, choice into centers, etc. websites, books on tape ,
provide a visual model etc. etc. allow to use
for practice, etc. overhead/ELMO etc.
Adaptations/accommodations/modifications that are needed:
___________________________________________________________________________________________________________
Description of how children will be assessed or are able to show what they have learned through multiple
ways of expression: Product/Learning Check/Open Response/checklist or Exit Slip. List examples to be used.
Visual/Verbal and Auditory: I.e. Kinesthetic/Tactile: Affective: I.e. Technology
non verbal: I.e. Sing, tell through I.e. Puppet show, fill in Role play presentation, options: I.e.
Write, draw a picture or answering questions, give bubbles on answer grid, act out play, group Software that would
mural, make a chart or an oral report, etc. point to pictures, use demonstration, etc. track mastery of skill,
graph, portfolio, etc. materials to represent tape recording of answer
answers (manipulatives) to problem, etc.
etc.
Adaptations/accommodations/modifications that are needed:
Lesson plan reflects recommendations of Universal Design for Learning, DEC, KDE, and RtI Page 1

2. Tiered/Universal Design Lesson Plan Template
Tier 2 Instruction - Targeted and Temporary
Targeted outcome/practice skill: ____________________________________________ Date ____________
Design instruction to meet the skill deficits/strengths found in after initial screening or assessment with identified
children. Tier 2 can also support the needs of gifted/advanced children who need extension of skills. Meet in small,
planned groups or through individual child initiated center activity to increase engagement and support skill
mastery. Systematically collect data to monitor progress. Analyze data to determine how to alter instruction.
This instruction should be embedded within regular daily activities if possible. This tier is intended
to supplement, not replace Tier 1 instruction.
(Highlight one) Small group/ Reading group/ Math group/ Center/ Choice time.
Teacher Group Time Child name Child name Child name Child name
Group 1
(1-4)
Group 2
(1-4)
Systematic instruction to be used to practice skill:
Materials needed for instruction:
Progress monitoring tool/Data collection method to be used (attach):
Adaptations/accommodations/modifications needed:
Data Driven Decision Making/ how will the instruction be modified for non
responder/When will Tier 3 instruction begin if skill is not mastered?
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3. Tiered/Universal Design Lesson Plan Template
Tier 3 Instruction- Intensive and Intentional
Center/choice time of day-embed instruction within child’s choice of activity when
possible to promote engagement.
Skill to be acquired Individual Child Teacher length of session
Systematic instruction to be used (ex. direct instruction through discreet trials,
errorless learning etc.):
Materials needed for instruction:
Progress monitoring tool/Data collection to be used (attach):
Adaptations/accommodations/modifications needed:
________________________________________________________________________________________
Data Driven Decision Making/ Next step/ what are plans if skill is not acquired?
(Change the method of direct instruction/collaborate with special ed. Staff/go to
support team etc.)
Comments/notes:
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4. Tiered/Universal Design Lesson Plan Template
Additional Notes or Comments:
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