Form Gci-1021c - Child Indicators Summary
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1GCI-1021C (8-16) – Page 6
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
IFSP Type:
Arizona Early Intervention Program (AzEIP)
IFSP Date:
CHILD INDICATORS SUMMARY
CHILD’S NAME
DATE OF BIRTH
Entry
Exit
TYPE OF RATING
DATE OF RATING
Use the recent updates to the IFSP, annual assessments and other available information to rate the questions below using the following chart.
Overall Age Appropriate
Overall Not Age Appropriate
Completely
Somewhat
Emerging
Not yet
means:
means:
means:
means:
T
E
A
M
I
N
G
T = Child shows
E = Between
A = Child shows
M =
I = Child does not
N =
G = Child does not
functioning expected
Completely and
functioning
Between
yet show functioning
Between
yet show functioning
for his or her age in
Somewhat.
expected for his
Somewhat
expected of a child
Emerging
expected of a child his
all or almost all
Child’s functioning
or her age some of
and
of his or her age
and
or her age in any
everyday situations
the time and/or in
generally is
Emerging
in any situation.
Not Yet
situation. Child’s skills
some situations.
that are part of
considered
Child’s behaviors
and behaviors also
appropriate for
do not yet include
the child’s life.
Child’s functioning
and skills
is a mix of age
include immediate
any immediate
Functioning is
his or her age but
considered
there are some
appropriate and not
foundational skills
foundational skills
appropriate for
concerns about
appropriate
upon which to build
upon which to build age
his or her age.
the child’s
functioning.
age appropriate
appropriate functioning.
No one has any
functioning in this
Functioning might
functioning.
Child’s functioning
concerns about the
indicator area.
be described as like
Functioning might be
might be described as
child’s functioning in
that of a slightly
described as
like that of a much
this indicator area.
younger child.
like that of a
younger child.
younger child.
1.
POSITIVE SOCIAL-EMOTIONAL SKILLS (Including Social Relationships)
1a. To what extent does this child show age-appropriate functioning, across a variety of setting and situations,
on this indicator? (Enter T, E, A, M, I, N, G)
1b. Has the child shown any new skills or behaviors related to positive social-emotional skills (including positive
social relationships) since the entry assessment summary?
N/A, Entry Indicator
Yes
No
If Yes, describe progress below:
2.
ACQUIRING AND USING KNOWLEDGE SKILLS
2a. To what extent does this child show age-appropriate functioning, across a variety of setting and situations,
on this indicator? (Enter T, E, A, M, I, N, G)
2b. Has the child shown any new skills or behaviors related to acquiring and using knowledge and skills since
the entry assessment summary?
N/A, Entry Indicator
Yes
No
If Yes, describe progress below:
3.
TAKING APPROPRIATE ACTION TO MEET NEEDS
3a. To what extent does this child show age-appropriate functioning, across a variety of setting and situations,
on this indicator? (Enter T, E, A, M, I, N, G)
3b. Has the child shown any new skills or behaviors related to taking appropriate action to meet needs since the
entry assessment summary?
N/A, Entry Indicator
Yes
No
If Yes, describe progress below:
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