APPENDICES FORMS Word Documents EI 5031 ATD Request EI ...
APPENDICES FORMS Word Documents EI 5031 ATD Request EI ...
APPENDICES FORMS Word Documents EI 5031 ATD Request EI ...
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Part II<br />
OSC/<strong>EI</strong>OD_______________________________________________ <strong>Request</strong> Date_____/_____/_____<br />
(To be completed by pre-school teacher after reviewing Part I)<br />
There will be an observation of child at school.<br />
1. Size of class, age range, student-teacher ratio, how many children, how many staff<br />
members?<br />
2. Daily routine/schedule<br />
3. How is transition from one activity to the next accomplished?<br />
4. Are all directions verbal, i.e. – any visual prompts?<br />
5. Do you have the ability to modify, if necessary, the classroom environment to suit the<br />
needs of this child? If yes, please explain.<br />
_______________________________________ _____/_____/_____<br />
Pre-School Director Signature Date<br />
______________________________________ _____/_____/_____<br />
Parent Signature Date<br />
(DOH use only)<br />
[ ] Approved Numbers of Hours Per Week_________ From:____/_____/_____ To:_____/_____/_____<br />
[ ] Denied OSC/<strong>EI</strong>OD Signature________________________________________ Date:_____/_____/_____<br />
<strong>EI</strong> 5229.B 10/03
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