education
IFSP Sample Template
Child’s name ________________________ Age _______________________ Date ______________________
I. Statements of Family Strengths and Resources
II. Statements of Family Concerns and Priorities
*Concerns:
*Priorities:
III. Child’s Present Level of Development and Abilities
Cognitive Skills (Thinking, reasoning, and learning)
Communication Skills (Understanding, communicating with others, and expressing self with others)
Self- Care/Adaptive Skills (Bathing, feeding, dressing, and toileting)
Gross and Fine Motor Skills (Moving)
Social-Emotional Development (Feelings, coping, and getting along with others)
Health/Physical Development (Hearing, vision, and health)
IV. Outcome Statements
· Write one Goal with a strategy or activity that Dashawn must master before the next meeting in 6month.
· Write one goal with a strategy or activity that his parents must due before the next meeting in six months.