home visit

Handout 2.3

Page 1

CONNECT – 2010

http://community.fpg.unc.edu/connect-modules

Home Visit Planning Form

Child’s Name

Parent or Guardian Phone #

Address

Date of visit

Teacher/Provider

Materials for Home Visit

1. Transition Profile 2. Transition Plan from the Early Intervention program 3. Snapshots and/or video of classroom 4. Follow-up Home Visit Sheet (Classroom schedule, calendar, menu, pictures of other staff members) 5. Camera

Conversation Guide

Area Planning Notes Meeting Notes

1. Building rapport with the child and family

2. Family transition concerns and goals

3. Describe your program

4. Plan for next steps

1. Childs Name:
2. Parent or Guardian:
3. Phone:
4. TeacherProvider:
5. Planning Notes1 Building rapport with the child and family:
6. Meeting Notes1 Building rapport with the child and family:
7. Planning Notes2 Family transition concerns and goals:
8. Meeting Notes2 Family transition concerns and goals:
9. Planning Notes3 Describe your program:
10. Meeting Notes3 Describe your program:
11. Planning Notes4 Plan for next steps:
12. Meeting Notes4 Plan for next steps:
13. Address:
14. Date of visit: