Instructional Intervention Project Report Form

Instructions: Select 1 IEP objectives for 1 student and plan for the intervention. Approve plan
with cooperating teacher and supervisor. Once a solid plan is in place and approval is granted
you may begin the project. Document this assignment on a separate page, including the
information listed below.
Describe data collection form - how will you collect the data (data collection must be manageable
(i.e. do not collect data all day long)).
Baseline: You must have at least 3 data points.
Intervention: You need to define criteria for instructional intervention(s). Example: If the
performance does not improve after three data points, change the intervention. Example: If the
objective is met as defined (as independently as possible) at three data points, move on to a new
objective. If not, reflect, reevaluate, and modify your instruction. The data drives the process, not
a timeline.
Graph: Use Excel for graph (your visual representation of the process can be modified per your
instructor). Use phase change lines between baseline and intervention. Draw an arrow to
denote significant changes that may affect the data (e.g., began medication, fire drill).
You must be able to demonstrate that you used visual analysis (i.e., examined graph) to make
decisions regarding the intervention. Write a summary of what you did and what you learned;
submit this information along with your graph to your supervisor.
Student's Initials: G.C.

Time Period:

Age: 11

Data Points:

Grade: 6th

Gender: F

Targeted Behavior: Counting backwards from 75.

IEP Goal:
Mathematics Goal: Mathematics Goal: By her next annual ARD, given daily instruction and
number strategies, G will count to and from 75 with 100 percent accuracy for 5 trials.

By the end of the 4th 6 weeks, given daily instruction and number strategies, G will count
backwards from 75 with 100% accuracy for 5 trials.

Data Collection Form:

Intervention:
Data will be collected by giving G.C. a blank hundreds chart except for 75 and 1. She will
be asked to fill out the rest of the chart, orally, starting at 70.
Because she struggles with transferring from decade to decade, G.C. will use a hundreds
chart that is blank, except for the fives and decades to provide cues for her to achieve the
overall goal of counting backwards without visuals. She will orally recite the numbers
using the hundreds chart, starting at 75 and moving backward.
After a week, the fives column will be removed and data will be collected on the progress
that G.C. has made. She will begin at 75 and move backward.

After another week of this intervention, the following numbers will be removed: 20, 40, 60.
G.C. will be asked to fill in the rest of the chart, starting at 75.

Summary (attach graph):