Three-Tier RTI Template

Use this page as one active RTI record for a student or teacher trainee. Keep the plan focused on one priority need, one observable goal, and one current level of support.

Practical rule: Record only the information needed to decide what support to provide next.

Quick properties

• Current Tier: Tier 1 / Tier 2 / Tier 3

• Next Review: date

• Intervention Focus: short tag or category

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Quick Plan

**Student / Trainee:****Course / Cohort:****Date:**Review date:

Current level of support

• Tier 1: Core instruction for all

• Tier 2: Targeted small-group support

• Tier 3: Intensive individual support

1. What is the priority need?

Describe one clear concern and the observable evidence:

2. What should improve by the review date?

State one specific, observable goal:

3. What support will be provided?

Support / instructional action	Who	How often	Start date

How will progress be checked?

Name the task, measure, work sample, observation, or other evidence:

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Progress Notes

Date	Support provided	Evidence / result	Next step

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Review Decision

• Continue current support

• Adjust the support plan

• Step down a tier

• Move to a higher tier

• Close the RTI record

• Seek additional support

Brief review summary and next action

Commitments

**The student will:****The instructor will:****Other team member / note:**Next review:

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Workflow: Duplicate this page for each student or trainee. Use the Current Tier and Next Review properties to surface records needing attention.