KIT-RtI Initial Referral Form: Fill out & sign online

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Click ‘Get Form’ to open the KIT-RtI Initial Referral Form in our platform's editor.
Begin by filling in your name and the date at the top of the form. This identifies you as the referring teacher, staff member, parent, or student.
Enter the student's name, grade, and subject or activity. This information is crucial for the RTI/KIT Team to understand the context of your referral.
In the 'Reason for referral' section, check all applicable boxes: Attendance, Behavior, Academics, or Health. This helps prioritize concerns.
Provide a brief description of observed behaviors that prompted your concern. Include objective data to support your observations.
For academic concerns, list recent progress monitoring data and attach relevant assessment results and report cards as needed.
Detail social/behavioral concerns by describing frequency and intensity of problematic behaviors. Attach any office referrals if available.
Complete the Prior Interventions Checklist on the reverse side by indicating interventions attempted prior to this referral.
Finally, sign the form and either place it in a sealed envelope in the RTI/KIT Referral Box or email it to rtikit@hhs328.com.

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What is an example of a referral?

I wanted to take a moment to recommend a colleague of mine, [Colleagues Name], for the [Position] role at our company. I have worked alongside [Colleagues Name] for [Length of Time] and can attest to their skills, work ethic, and positive attitude.

How to fill out a referral form?

A referral form should include the name and contact information of the person making the referral, the name and contact information of the person or business being referred, and any relevant details about the referral.

What information is needed on a referral form?

It usually includes the patients personal information (e.g., name, age, address etc.), their medical history, the reason for the referral, and the referring doctors information.

How do I fill out a referral form?

The RTI approach provides opportunities for early identification, for a more prevention-oriented approach, and, perhaps most importantly, for schools to screen every student and give every student an opportunity to be provided additional instruction if they need it, rather than being completely dependent upon teachers

How do I write a referral form?

How to write a letter of referral Include both addresses. Write a brief introduction. Give an overview of the applicants strengths. Share a story of the applicant. Add a closing statement. Leave a signature.