Early Childhood Outcomes Progress Summary Form

Virginia Department of Education Early Childhood Outcomes Progress Summary Form

Student Name ______Student I.D. ______Student D.O.B. ______

Entry Status (Time 1) Exit Status (Time 2) Date of entry into program ______Date of exit from program ______Age at entry ______Age at exit ______

Persons involved in deciding the summary ratings:

Time 1 Time 2 Name Role Name Role

Family information on child functioning (Check all that apply) Family information on child functioning (Check all that apply) ___ Received in team meeting ___ Received in team meeting ___ Collected separately ___ Collected separately ___ Incorporated into assessment(s) ___ Incorporated into assessment(s) ___ Not included ___ Not included 1a. AGE APPROPRIATE SOCIAL-EMOTIONAL SKILLS 1b. AGE APPROPRIATE SOCIAL-EMOTIONAL SKILLS (INCLUDING SOCIAL RELATIONSHIPS) (INCLUDING SOCIAL RELATIONSHIPS)

Please refer to the guiding questions when discussing the child’s functioning level and fill out the progress scale below. 1b. To what extent does this child show same age functioning, across a variety of settings and situations, on this outcome? 1a. To what extent does this child show same-age functioning, (Circle one number) across a variety of settings and situations, on this outcome? (Circle one number) Supporting evidence for answer to Question 1b

Not Yet Emerging Somewhat Completely Not Yet Emerging Somewhat Completely 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Supporting evidence for answer to Question 1a

Please refer to the guiding questions when discussing the child’s functioning level 2a. ACQUISITION AND USE OF KNOWLEDGE AND SKILLS and fill out the progress scale below. (INCLUDING EARLY LANGUAGE/COMMUNICATION AND EARLY LITERACY) Source of informatio Source of n Date Summary of Relevant Results information Date Summary of Relevant Results Please refer to the guiding questions when discussing the child’s functioning level 2b. To what extent does this child show same-age functioning, and fill out the progress scale below. across a variety of settings and situations, on this outcome? (Circle one number) 2a. To what extent does this child show same-age functioning, across a variety of settings and situations, on this outcome? Not Yet Emerging Somewhat Completely (Circle one number) 1 2 3 4 5 6 7

Not Yet Emerging Somewhat Completely Supporting evidence for answer to Question 2b.

1 2 3 4 5 6 7 Supporting evidence for answer to Question 2a

2b. ACQUISITION AND USE OF KNOWLEDGE AND SKILLS (INCLUDING EARLY LANGUAGE/COMMUNICATION AND EARLY LITERACY)

Please refer to the guiding questions when discussing the child’s functioning l evel and fill out the progress scale below.

Source of Date Summary of Relevant Results Source of informatio informatio n Date Summary of Relevant Results n Date Summary of Relevant Results Student Name: Summary Date: Summary Date:

3a. USE APPROPRIATE BEHAVIORS TO MEET THEIR NEEDS Please refer to the guiding questions when discussing the child’s functioning l evel and fill out the progress scale below. Please refer to the guiding questions when discussing the child’s functioning level and fill out the progress scale below. 3b. To what extent does this child show same age functioning, across a variety of settings and situations, on this outcome? 3a. To what extent does this child show same age functioning, (Circle one number) across a variety of settings and situations, on this outcome? (Circle one number) Not Yet Emerging Somewhat Completely

1 2 3 4 5 6 7 Not Yet Emerging Somewhat Completely Supporting evidence for answer to Question 3b. 1 2 3 4 5 6 7 Supporting evidence for answer to Question 3a

Source of Source of informatio informatio n Date Summary of Relevant Results n Date Summary of Relevant Results

3b. USE APPROPRIATE BEHAVIORS TO MEET THEIR NEEDS