education

IFSP Sample Template

Child’s name ________________________ Age _______________________ Date ______________________

Service Coordinator_(this will be you)_________________________________ Review Date _(the date you

submit)_____________________

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.