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
