Early Intervention Progress
Report and Transition
Name of Agency: ___________________________________ Date of Report: _________________
Provider’s Name/Discipline/License #: ________________________________________________
Child’s Name: __________________________________________ DOB: _________________
Service Coordinator: _______________________ IFSP dates: ____________ to: ______________
How many times per week is the service authorized? ______________________
Date you started working with the child: _________________________________
If there have been any gaps in service delivery or numerous cancellations of scheduled
visits – describe the length and reason(s) for the gaps.
What IFSP outcome(s) have you been addressing?
What strategies have been used to work towards these outcomes?
What progress has been made?
What techniques have you taught the parent/caregivers to include in the child’s daily
Do not alter Essex County Forms they have been designed to meet State and Federal requirements.
Based on your current assessment, what is the child’s current level of functioning?
Include current age equivalence and/or standard score, method of assessment, testing
instrument used, etc.
Recommendations for the next six months. (Include suggested changes in objectives,
strategies/techniques and activities).
Transition planning: If child has turned three or has a third birthday within the next six
month IFSP period please address the following:
Provider’s recommendations for the child upon discharge from Early Intervention:
If services under CPSE are recommended, list goals and benchmark objectives for
preschool services:
I certify that I have provided the above services in accordance with the frequency and
duration mandated in the IFSP, and have worked toward addressing the relevant
outcomes set forth in the IFSP. I further certify that my responses in this report are an
accurate representation of the child’s current level of functioning.
Signature & Title of EI provider: ____________________________________________________
Date: ____________________________________
EI provider progress report 4/06