DRDP (2015): An Early Childhood Developmental Continuum – Preschool Comprehensive View – June 24, 2019 © 2013–2019 California Department of Education – All rights reserved Intro-11 of 18
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 CASEMIS)
6. Statewide Student Identier (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)
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.
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 Pacic 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
Specic 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?
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.