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Trailblazer Elementary School
ACT Referral Procedure
(Advocates for Children of Trailblazer)

 
1.1.  Obtain an ACT referral form located in the office.

 

At the beginning of the year, wait at least two weeks before referring a student.
When a new student enrolls during the year, allow at least a two week adjustment
period before referring if you have concerns. Please be sure that you contact the
parent in person or by phone to discuss concerns
before beginning this process. The procedure for the referral is as follows:
  • a.  a.Complete the ACT Referral Form, front side only. The Action Plan on the back of the form will be completed during the meeting. Include information from any staff member who is in contact with the child.
  • b. Return the completed form to the ACT team Manager.
  • c. The ACT team will review data and prepare for the intervention meeting.
  • d. Involved parties will be notified of the time and date for the child’s intervention meeting. Meetings will begin at _______on ______________.

The classroom teacher will be responsible for notifying the parents of the ACT meeting time and date.

 
2. All involved parties will attend the ACT intervention meeting where an Action
 Plan will be written. The following may be discussed at the ACT meeting:
  • a.Behaviors of concern
  • b.The extent to which patterns have emerged
  • c.Alternative hypotheses based on areas of expertise
  • d.Strengths/weaknesses of student
  • e.Need for assessment-formal or informal
  • f.Supports available within the school community
  • g.Possibilities for outside assistance
  • h.Next steps
  • i.Parties responsible for follow-through
  • j.Timeline for intervention strategies
k.
3. A follow-up date will be tentatively scheduled at that time. Teachers always have the
option to schedule follow-up intervention sessions as needed:
  • a.To determine if new steps are necessary.
  • b.If additional problems are identified.
c.
4. The ACT team Manager will then complete the follow-up and place paperwork in the
child’s cumulative folder.
 
5. If NO follow-up meeting is necessary, contact the ACT  manager before the next 
scheduled meeting.