Fillable DRDP (2015) Child Information Observer Information Information Page (Desired Results for Children and Families)

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DRDP (2015) Child Information Observer Information Information Page (Desired Results for Children and Families)

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DRDP (2015): An Early Childhood Developmental Continuum – Preschool Fundamental View – June 24, 2019 © 2013–2019 California Department of Education – All rights reserved Intro-10 of 18
Observer Information
9. Agency: Site:
10. Your name: Title:
11. Are you the primary teacher working with this child?
Yes
No (specify your relationship to the child):
12. Did another adult assist you with assessing this child?
Yes (role/relation):
No
DRDP (2015)
Early Education
Information Page
An Early Childhood
DevelopmentalContinuum
Foruse with Early Care and
EducationPrograms
1a. Child’s rst name (Legal):
1b. Child’s last name (Legal):
Date DRDP (2015) was completed (mm/dd/yyyy)
Assessment period (e.g., Fall 2016)
Child Information
2. Statewide Student Identier (10-digit SSID):
3. Agency Identier:
(agency identier and statewide student identier can be the same)
4. Child’s classroom or setting:
5. Birth date (mm/dd/yyyy):
6. Gender Male Female
7. Initial date of enrollment in early childhood program (mm/dd/yyyy):
Date child was withdrawn from the program (mm/dd/yyyy):
8a. What is this child’s ethnicity?
Yes, Hispanic or Latino No, not Hispanic or Latino
8b. What is this child’s race? Mark one or more races to indicate what this child considers himself/herself to be.
Asian Indian
Black or African-American
Cambodian
Chinese
Filipino
Guamanian
Hawaiian
Hmong
Japanese
Korean
Laotian
Native American
Other Asian
Other Pacic Islander
Samoan
Tahitian
Vietnamese
White
Intentionally left blank
Child’s Language Information
13. Child’s home language(s):
Is a language other than English spoken in the child’s home? Yes No
If yes, the ELD measures must be completed for a preschool-age child
14. What language(s) do you speak with this child?
15. Did someone who understands and uses the child’s home language assist you with
completing the observation?
Yes, role/relation:
No Not applicable (I understand and use the child’s home language)
16. Child is enrolled in: Check all that apply.
State Infant/Toddler Program
State Preschool
Head Start
Early Head Start
Child Care Center
Tribal Head Start
Migrant
First 5
Title 1
Family Child Care Home
Other:
Child’s tuition fees are:
Subsidized (tuition assistance) Not subsidized (full fee) Don’t know
17. Does this child have an Individualized Education Program (IEP) or an Individualized Family
Service Plan (IFSP)? Yes No Don’t know
DRDP (2015): An Early Childhood Developmental Continuum – Preschool Fundamental View – June 24, 2019 © 2013–2019 California Department of Education – All rights reserved Intro-11 of 18
Use this Information Page for a child with an Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) served by a California Department of Education program.
DRDP (2015)
Special Education
Information Page
An Early Childhood Developmental Continuum
For use with Early Intervention and
Early Childhood Special Education
Programs
1. Child’s rst name (Legal):
2. Child’s last name (Legal):
3. Date DRDP (2015) was completed (e.g., 09/07/2015)
4. Assessment period (e.g., Fall 2015)
Child Information
5. Student ID (Issued by district for reporting to CDE, SED)
6. Statewide Student Identier (10-digit SSID)
7. Gender Male Female
8. Birth date (e.g., 03/05/2012)
9. Special education enrollment. Check one.
Individualized Family Service Plan (IFSP) Individualized Education Program (IEP)
Child’s Language Information
10. Child’s home language(s):
English
Vietnamese
Hmong
Spanish
Cantonese
Tagalog/Pilipino
Other (specify)
Child’s Ethnicity
13a.
Is this child Hispanic or Latino? Check one.
Yes, Hispanic or Latino No, not Hispanic or Latino Intentionally left blank
13b.
What is the race of this child? Check up to three.
Asian Indian
Black or African-American
Cambodian
Chinese
Filipino
Guamanian
Hawaiian
Hmong
Japanese
Korean
Laotian
Native American
Other Asian
Other Pacic Islander
Samoan
Tahitian
Vietnamese
White
Intentionally left blank
Special Education Information
14. Special education eligibility. Check one.
Autism
Deaf-Blindness
Deafness
Emotional Disturbance
Established Medical
Disability
Hard of Hearing
Intellectual Disability
Multiple Disability
Orthopedic
Other Health
Impairment
Specic Learning
Disability
Speech or Language
Impairment
Traumatic Brain Injury
Visual Impairment
15. Adaptations used in the assessment. Check all that apply.
Augmentative
or alternative
communication system
Alternative mode for written language
Visual support
Assistive equipment or device
Functional positioning
Sensory support
Alternative response mode
None
Program Information
16. SELPA
17. District of service
Assessment Information
18. Name of person completing the assessment
19. Role of person completing the assessment:
Early Intervention Specialist
Occupational/Physical Therapist
Program Specialist or Administrator
Special Education Teacher
Speech/Language Pathologist
Teacher of the Deaf/Hard of Hearing
Teacher of the Visually Impaired
Other
20. Assistance completing the assessment? Yes No
If yes, what is that person’s relationship to the child?
11. Language(s) used with this child:
English
Vietnamese
Hmong
Spanish
Cantonese
Tagalog/Pilipino
Other (specify)
12. Is a language other than English spoken in the child’s home? Yes No
If yes, complete the ELD measures for a preschool-age child.
If the child is Deaf or Hard of Hearing and not learning a spoken language, mark “No” and do not complete the ELD measures.
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DRDP (2015) Child Information Observer Information Information Page (Desired Results for Children and Families)

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Completed 27 February 2021

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