South Carolina Association of Community Action Partnerships
Early Head Start Child Care Partnerships
Individualized - Child Observation and Planning
Child's Last Name:
*
Child's First Name:
*
Child's Middle Name:
Parent’s Name/nombre de padre/madre:
*
Phone Number:
Center:
*
Betty's Daycare
House of Joy
House of Smiles
Kiddie University
Little Smurf's
Midlands Primary
Newberry CDC
Pawley's Island
Progressive Family Life CDC
Small Minds of Tomorrow II
Thornwell
Wright Way CDC
Wright's DayCare
Person Completing Form:
Date:
Age:
Development Domain (Check one)
Social Emotional
Physical
Language
Cognitive
Literacy
Math
Individual Child Goal:
Goal worked on during (Check Routines/ Experiences that apply)
Hellos and Good-Byes
Diapering and Toileting
Eating and Mealtime
Sleeping and Nap Time
Getting Dressed
Playing with Toys
Imitating and Pretending
Enjoying Stories and Books
Music and Movement
Art
Tasting and Preparing Food
Exploring Sand and Water
Going Outdoors
Observations
(what the child is currently doing as it relates to the above goal):
Explain how the teacher will use “Observation” to individualize Routine and Experiences for this child (*Note any changes to environment, materials, arrangement, of space etc.)
I confirm that I have read and understand this form.
*
By checking this option, I choose to manually sign this form.
Clear Signature
Signature required
Please check any one sign.
By checking this option, I prefer to have the system electronically sign this form for me.
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Parent Signature
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