DATE:  ________________________________________________________________________ 
TEACHER: _____________________________________________________________________

EQ: How can data be used to support a “TAKE TWO/ OWN TWO” student, and what guidance can be offered to help them grow academically?

Name of student: ____________________________________________________________
Data on “TAKE TWO/ OWN TWO” student:		
Universal Screening Fall Reading:	   Universal Screening Fall Math:	
		
   Universal Screening Winter Reading:	   Universal Screening Winter Math:	

List any known background information about your student: ____________________________________________________________________________________________________________________________________________________________
List any questions you may still have about your student: ____________________________________________________________________________________________________________________________________________________________
Write the day(s) and time(s) you meet with your student: ____________________________________________________________________________________________________________________________________________________________
Share the ways how you inform the parents of your student: ____________________________________________________________________________________________________________________________________________________________
List other staff members involved with this student in case of assistance: ____________________________________________________________________________________________________________________________________________________________
List any rewards for growth that were established between you and the student: ____________________________________________________________________________________________________________________________________________________________