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To record your Data Summary, complete the information below and then click the "Submit" button at the bottom of the form.
ALL fields are required to have an entry. If "In Place" is selected, mark "NA" under Priority for Improvement

ABC-UBI TEAM SELF-ASSESSMENT (Secondary Version)
Team Name
Season/Year
Assessment Date (use format MM/DD/YYYY ex. 08/27/2011)
Current Status
Feature
Priority for Improvement
In Place
Part in Place
Not in Place
Systems Level Support
mark "NA" only if status is "In Place"
In Part Not
1. Complete application and turn into district coach or state team.
High Med Low NA
In Part Not
2. Attend team trainings and makes a plan for dissemination of information to staff.
High Med Low NA
In Part Not
3. Determine priorities and align with school improvement plan.
High Med Low NA
In Part Not
4. Administrative support for implementation of RTI and participation with ABC-UBI.
High Med Low NA
In Part Not
5. Consensus activities with staff to ensure 80% faculty buy in.
High Med Low NA
In Part Not
6. Data on RTI outcomes are shared with faculty at least quarterly.
High Med Low NA
In Part Not
7. Teaming structures (ABC-UBI, PLC's, TST's) have clearly defined roles and responsibilities.
High Med Low NA
In Part Not
8. A quarterly action plan is used by the ABC-UBI team to guide implementation of RTI.
High Med Low NA
In Part Not
9. A funding request is submitted to facilitate the implementation of RTI.
High Med Low NA
In Part Not
10. The ABC-UBI Systems team meets at least twice a month to review data and implementation details.
High Med Low NA
In Part Not
11. The ABC-UBI Systems team uses the Problem Solving Model at team meetings.
High Med Low NA
In Part Not
12. The ABC-UBI Systems team submits monthly meeting notes.
High Med Low NA
In Part Not
13. System selected for tracking behavioral data. (e.g., Discipline Tracker, Excel, Educators Handbook, District System, SWIS).
High Med Low NA
In Part Not
14. System selected for tracking academic data (e.g., Dibels, AIMSWEB, CBM Focus).
High Med Low NA
In Part Not
15. Compile school systems manual/handbook to ensure institutional memory.
High Med Low NA
In Place
Part in Place
Not in Place
Tier 1 Behavioral Support (All Students)
mark "NA" only if status is "In Place"
In Part Not
1. Establishment of school-wide rules and expectations.
High Med Low NA
In Part Not
2. Posted school-wide rules and expectations.
High Med Low NA
In Part Not
3. Expected student behaviors, such as rules and routines, are taught quarterly.
High Med Low NA
In Part Not
4. Expected student behaviors are reinforced regularly (>4 positives to 1 negative).
High Med Low NA
In Part Not
5. School wide discipline plan includes clearly defined consequences for rule violations.
High Med Low NA
In Part Not
6. School wide discipline plan includes procedures for addressing emergency/dangerous situations.
High Med Low NA
In Part Not
7. All classrooms consistently implement the school wide discipline plan for addressing rule violations (Major infractions-Office Managed, Minor infractions-Classroom Managed).
High Med Low NA
In Part Not
8. Office Discipline Referral Form (ODR) includes: student name/grade, date, time, referring staff, problem behavior, location, others involved, probable motivation and administrative decision.
High Med Low NA
In Part Not
9. School wide behavioral data are summarized monthly (e.g., ODRs, majors/minors, OSS, ISS, tardies, etc).
High Med Low NA
In Part Not
10. School wide behavioral data are used to evaluate the effectiveness of core behavior program (e.g., ≥80% of students have 0-1 ODR's).
High Med Low NA
In Part Not
11. School climate assessed using student surveys.
High Med Low NA
In Place
Part in Place
Not in Place
Not Applicable
Tier 1 Academic Support
(All Students)
mark "NA" only if status is "In Place"
In Part Not NA
1. Universal benchmarking for reading administered (3 times/year).
High Med Low NA
In Part Not NA
2. Universal benchmarking for math administered (3 times/year).
High Med Low NA
In Part Not NA
3. The school has extablished evidence based core/Tier 1 instructional reading programs.
High Med Low NA
In Part Not NA
4. Adequate time (90-120 minutes) allocated every day for Core/Tier 1 classroom reading instruction.
High Med Low NA
In Part Not NA
5. The school has established evidence based core/Tier 1 instructional math programs.
High Med Low NA
In Part Not NA
6. Adequate time allocated every day for Core/Tier 1 classroom math instruction.
High Med Low NA
In Part Not NA
7. School wide data are presented to staff after each benchmarking session (e.g., staff meetings, team meetings, grade-level meetings).
High Med Low NA
In Part Not NA
8. School wide universal benchmarking data are submitted/reported quarterly.
High Med Low NA
In Part Not NA
9. School wide data are used to evaluate the effectiveness of core academic programs; ≥80% of the school population is at benchmark.
High Med Low NA
In Place
Part in Place
Not in Place
Tier 2 Behavioral Support
(10-15% of enrollment)
mark "NA" only if status is "In Place"
In Part Not
1. School wide behavioral data (ODR's) are used to identify students who need supplementary interventions (10-15% of enrollment/2-5 ODR's a year).
High Med Low NA
In Part Not
2. The school has established evidenced based Tier 2/supplemental behavioral interventions/supports for students who engage in frequent problem behavior (2-5 ODR's a year).
High Med Low NA
In Part Not
3. Student progress monitoring data are utilized to determine response to Tier 2/supplemental behavioral interventions/supports.
High Med Low NA
In Place
Part in Place
Not in Place
Not Applicable
Tier 2 Academic Support
(10-15% of enrollment)
mark "NA" only if status is "In Place"
In Part Not NA
1. Universal benchmarking data are used to identify students needing Tier 2 supplemental academic support.
High Med Low NA
In Part Not NA
2. The school has established evidence based Tier 2/supplemental academic interventions/supports.
High Med Low NA
In Part Not NA
3. Time is allocated on a daily basis for supplemental/Tier 2 instruction in addition to Core/Tier 1 instruction.
High Med Low NA
In Part Not NA
4. Data (e.g., quick diagnostic, survey level assessment, phonics screener) are used to create small homogenous groups for students needing Tier 2/supplemental interventions/supports.
High Med Low NA
In Part Not NA
5. Student progress monitoring data are utilized to determine response to Tier 2/supplemental academic interventions/supports.
High Med Low NA
In Place
Part in Place
Not in Place
Tier 3 Behavioral Support
(1-8% of enrollment)
mark "NA" only if status is "In Place"
In Part Not
1. School wide behavioral data are used to identify students who engage in chronic problem behavior (1-8% of enrollment/6+ ODR's a year, and data from students who did not respond to Tier 2 interventions).
High Med Low NA
In Part Not
2. Functional behavioral assessment is used to identify interventions for students who engage in chronic problem behavior.
High Med Low NA
In Part Not
3. Student progress monitoring data are utilized to determine response to Tier3/intensive behavioral interventions/supports.
High Med Low NA
In Place
Part in Place
Not in Place
Not Applicable
Tier 3 Academic Support
(1-8% of enrollment)
mark "NA" only if status is "In Place"
In Part Not NA
1. Intensive/Tier 3 evidence based programs are in place to support students who do not show progress from the Tier 2/supplemental academic interventions/supports.
High Med Low NA
In Part Not NA
2. Time is allocated on a daily basis for intensive/Tier 3 instruction in addition to Core/Tier 1 instruction.
High Med Low NA
In Part Not NA
3. Student progress monitoring data are utilized to determine response to Tier 3/intensive academic interventions/supports.
High Med Low NA

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