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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(Team Leader to complete Part I first)<br />
Part I<br />
Nassau County Early Intervention Program<br />
Pre-School Transition Plan/IFSP Amendment for ABA<br />
Child’s Name: Date of birth: _____/_____/_____<br />
1. How long has child been receiving ABA?<br />
2. What abilities is the child demonstrating that have prompted consideration for attending a<br />
community pre-school?<br />
3. Describe the child’s social skills<br />
a) Eye contact<br />
b) Play skills<br />
c) Attending skills<br />
d) Ability to transition from one activity to the next<br />
4. Communication skills<br />
a) Child’s ability to express needs<br />
b) Child’s ability to follow verbal directives<br />
c) Describe alternative communication methods in place to enable child to communicate ie: visual<br />
aides<br />
5. Behavioral & Safety Concerns<br />
6. Feeding Issues<br />
7. What other social interactions has the child had, both in & out of the home?<br />
______________________________________ _____/_____/_____<br />
ABA Team Leader’s Signature Date over ⇐<br />
<strong>EI</strong> 5283.A 7/06
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