Family Activity Sheet for ________________________________
Week of ___________________
Activity 1
The IFSP Outcome
Date: ____________
and/or goals:
Time: ____________
The daily routine
Interventionist:
& the steps for the
_______________
Learning Activity
GREAT OKAY HARD
Family Feedback
We will continue activity
We changed the activity
We are ready for a new activity
Continue Activity?
Other Comments
Activity 2
The IFSP Outcome
and/or goals:
Date: ____________
The daily routine
Time: ____________
& the steps for the
Interventionist:
Learning Activity
_______________
GREAT OKAY HARD
Family Feedback
We will continue activity
We changed the activity
We are ready for a new activity
Continue Activity?
Other Comments
Activity 3
The IFSP Outcome
and/or goals:
Date: ____________
The daily routine
Time: ____________
& the steps for the
Interventionist:
Learning Activity
_______________
GREAT OKAY HARD
Family Feedback
We will continue activity
We changed the activity
We are ready for a new activity
Continue Activity?
Other Comments
Comments & Ideas: ________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
NYC EIP Family Activity Sheet (Voluntary Family Tool) 3 2013