Literacy Lab Referral Form
North Branford High School
Student Name: *
Your answer
Grade Level *
Data Team Review
The NBHS Data Team reviews at least three standardized assessments (or series of assessments). If students perform below proficiency on two of the three assessments, their English and Social Studies teachers are asked to consider whether or not they would benefit from increased support in a literacy lab environment.

The assessments are the standardized 8th grade measure from NBIS (iReady), the 8th grade results from Smarter Balanced, the PSAT 8/9 or PSAT 10/11, and/or the SWR scores from Social Studies common assessments.

For more information on the results of those assessments for individual students, please see Mr. Gwudz or Mr. Ford.

Teacher Perspective/Feedback
English or Social Studies Teacher Completes
Teacher Name *
Do you feel that the above-named student would benefit from additional literacy support? *
Please list additional assessments (other than the ones listed in the Data Team section) and the grades received on those assessments that you feel provide additional support for your decision. You may include such things as the 9th grade research paper or other essays, vocabulary quizzes, unit tests, etc. *
This list can be bulleted
Your answer
Major Areas of Concern in Reading and Writing
Classroom Teacher Completes
Reading (check all that apply) *
Required
Writing (check all that apply) *
Required
Universal Strategies Implemented
Classroom Teacher Completes
General, Universal Instructional Strategies *
Required
Reading *
Required
Writing *
Required
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