An MTSS referral form is the document you submit to a school’s Multi-Tiered System of Supports team to request additional academic or behavioral help for a student. Parents, teachers, counselors, and other school staff can all start one. The form captures who the student is, what the concern looks like in data, what has already been tried in the classroom, and what kind of help is being requested. Layouts vary by district, but the core information schools ask for is consistent, and a strong referral is mostly a matter of walking in with the right documentation already in hand.
Who Can Submit One
You do not need to be a school employee to start the process. If you are a parent and your child’s teacher has not raised concerns but you see struggles at home with homework, reading, or emotional regulation, you can fill out the form yourself. Ask the front office or the school’s MTSS coordinator for a blank copy. Some districts post the form on a parent portal or student-services webpage. Others keep it behind the counter and hand it out on request.
Teachers and counselors typically have faster access through internal systems, but the referral carries the same weight regardless of who submits it.
What to Gather Before You Fill It Out
The strongest referrals arrive with data already organized. Scrambling to collect records after submission slows everything down and gives the team less to work with at the first meeting.
Screening and Assessment Data
Most schools run universal screenings two or three times a year to flag students who may be falling behind. Results from tools like DIBELS, AIMSweb, or MAP are the single most useful piece of evidence on a referral, because they are built specifically to identify at-risk students. They are different from quizzes or classroom assignments, which measure what a student learned in a particular unit but are not designed to predict who needs intervention.
Teachers should pull the student’s most recent screening scores and any benchmark data that shows a trend over time. Parents who do not have access to these scores can request them from the school. You are entitled to see your child’s educational records. Screening data matters more than a single test grade because MTSS teams use it to compare a student’s trajectory against grade-level expectations.
Grades, Work Samples, and Attendance
These round out the picture. A student earning Ds in reading but As in math tells the team something different than a student failing across the board. Attendance records are especially relevant when struggles might stem partly from missed instruction rather than a skill deficit. The intervention plan looks different in each case.
What’s Already Been Tried
The team wants to see what the classroom teacher has already done before approving more intensive help. Keep a log that includes the specific strategy (small-group reteaching, modified assignments, extended time), how often it was provided, how long it lasted, and whether performance changed. A follow-up window of six to eight weeks is common in many districts before a team revisits the data and decides whether to adjust.
This documentation is not about proving the teacher tried hard enough. It gives the team baseline evidence about what works and what does not, so they can design an intervention that targets the actual gap instead of repeating what already failed.
Filling Out the Form Section by Section
Layouts differ, but most MTSS referral forms share the same core sections.
Student Identification
Enter the student’s full legal name, date of birth, grade level, and school. Many forms also ask for a student ID number. If the student receives any existing services, such as English-language support or a 504 plan, note that here. Errors in the ID number or name spelling can cause filing delays if the school’s data system cannot match the referral to the right student record.
Reason for Referral
This is the most important section. Be specific. “Struggling in reading” is a starting point, but “reads 35 words per minute when the grade-level benchmark is 90, and has not improved after eight weeks of small-group phonics instruction” gives the team something actionable.
If the concern is behavioral, describe what the behavior looks like, when and where it happens, and how often. Avoid diagnostic labels. You are describing what you observe, not making a clinical judgment.
Current Tier and Intervention History
Forms usually ask what level of support the student currently receives. Tier 1 is the general classroom instruction every student gets. Tier 2 is small-group targeted intervention, typically three to five students. Tier 3 is intensive, individualized support for students who did not respond to Tier 2. Note which tier the student is in and why it is not enough.
Transfer the documentation you gathered into the intervention history section. List each strategy, the dates it ran, how often the student received it, and the outcome. Attach progress-monitoring data if the form allows. Some districts include a pre-referral checklist that prompts you to confirm you have reviewed universal screener results, office discipline referral summaries, attendance trends, and classroom observation notes.
Requested Support
Some forms ask you to indicate what type of help you believe the student needs. Others leave this to the MTSS team. If you have a recommendation based on the data, include it, but don’t worry about getting the “right” answer. The team will design the plan collaboratively.
Submitting the Form
Submit through whatever channel your district uses. Many schools have moved to electronic platforms that timestamp the submission, which creates an automatic record. If your school still uses paper forms, hand-deliver a signed copy to the MTSS coordinator or the principal’s office and ask for a dated receipt or email confirmation. Keep your own copy.
After submission, the MTSS team reviews the referral and schedules a meeting. Composition varies, but typically includes an administrator, the classroom teacher, a school psychologist or counselor, and relevant specialists such as a reading interventionist or special education teacher. Parents are part of this process and should expect to be invited to the meeting or at least informed of its outcome.
At the meeting, the team reviews the data, confirms or refines the area of concern, and either designs an intervention plan or determines that the current tier is appropriate. If a new intervention is put in place, the team sets a progress-monitoring schedule and a follow-up date to evaluate whether the student is responding.
You Can Request a Special Education Evaluation at the Same Time
This is where many parents get tripped up. A parent can request a formal special education evaluation at any point during the MTSS process. Federal regulations are explicit: either a parent or a school district may initiate a request for an initial evaluation to determine whether a child has a disability.
A school cannot use MTSS as a gatekeeping step that must be completed first. The U.S. Department of Education’s Office of Special Education Programs addressed this in a 2011 memorandum, stating that “the use of RTI strategies cannot be used to delay or deny the provision of a full and individual evaluation” and that it “would be inconsistent with the evaluation provisions” for a school to “reject a referral and delay provision of an initial evaluation on the basis that a child has not participated in an RTI framework.”
If you request an evaluation and the school agrees, it must complete the evaluation within 60 days of receiving your written consent, unless your state has established a different timeframe. If the school denies your request, it must provide written notice explaining why it does not suspect a disability and what information it relied on in reaching that decision.
If the School Delays or Denies Action
Schools are required under the Child Find provision of IDEA to identify, locate, and evaluate all children with disabilities residing in the state, including children who are advancing from grade to grade. If your child is struggling and the school is not responding within a reasonable timeframe, you have several options.
- Put everything in writing. Submit your concern or evaluation request as a dated letter or email to the principal and the special education director. Written requests create a paper trail.
- Request written notice. If the school refuses to act, ask for the required written explanation under 34 CFR 300.503. The school must describe what action it is refusing, why, what information it considered, and what other options it evaluated.
- File a state complaint. Every state education agency accepts complaints alleging that a school district has violated IDEA requirements. The state must investigate and issue a decision, typically within 60 days.
- Request a due process hearing. This is a more formal legal proceeding where an impartial hearing officer reviews the dispute and issues a binding decision.
If the school conducted an evaluation and you believe it was inadequate, you can request an independent educational evaluation at public expense. If the school objects, it must file for a due process hearing to defend its own evaluation. Private evaluations paid out of pocket typically run between $1,000 and $7,800 depending on your location and the evaluator’s specialty, so knowing your right to a publicly funded one can save significant money.
Professional educational advocates who specialize in MTSS and special education charge roughly $100 to $300 per hour. They can attend meetings with you, review documentation, and help you understand whether the school is following federal requirements. Many parents navigate the process successfully on their own once they understand the rights above.