MTSS Problem-Solving Team Referral Form

Support Every Student with Data-Driven MTSS Referrals

When a student needs additional support, clear documentation and data are essential. This MTSS Problem-Solving Team Referral Form helps educators systematically document student concerns, baseline performance data, intervention attempts, implementation fidelity, and escalation criteria—all in one organized submission.

Built specifically for K-12 schools implementing multi-tiered systems of support (MTSS or RTI frameworks), this template ensures that problem-solving teams receive complete information to make informed decisions about next steps for students who may need intensified interventions or further evaluation.

Designed for Special Education and Student Support Teams

Whether you're a classroom teacher, special education coordinator, school psychologist, or intervention specialist, this form template streamlines the referral process by:

• Documenting baseline data including current performance levels, assessment results, and areas of concern
• Recording intervention history with details about what's been tried, duration, frequency, and outcomes
• Tracking fidelity to ensure interventions were implemented as designed
• Establishing clear escalation criteria that justify the need for problem-solving team involvement
• Organizing supporting documentation and data points in one centralized submission

The structured format ensures consistency across referrals and helps teams quickly identify patterns, gaps, and appropriate next steps for each student.

Automate Your MTSS Workflow with Stepper

Once a referral is submitted, you can use Stepper to automatically route submissions to the appropriate team members, create case folders, schedule problem-solving meetings, notify parents, and update your student information system—turning each referral into a coordinated, multi-step support process.

Built on Paperform: Professional, Secure, and Easy to Customize

This template is powered by Paperform, the flexible form builder trusted by school districts and educational organizations worldwide. Customize the form to match your district's MTSS framework, add your school branding, adjust intervention categories to reflect your programs, and ensure all submissions are securely stored with SOC 2 Type II compliance.

Whether you're supporting academic concerns, behavioral challenges, or social-emotional needs, this MTSS referral form helps your team make data-informed decisions that put student success first.