Example Transition Planning Form

EXAMPLE TRANSITION PLANNING FORM

(Adapted from State of Arizona materials . Arizona Early Intervention Program -http://www.de.state.az.us/azeip/ )

Part I

Invitation to Participate in a Transition Planning Conference TO: (Name of designated receiving agency contact person.)

You are invited to a meeting to develop the transition plan for ___(Child's Name)___ who is currently enrolled in our agency.s EI program and resides in the ____________________School District. The child.s date of birth is ___(mm/dd/yy)___. The meeting will assist the parent(s) and their team to understand and plan the transition process from early intervention to the appropriate early childhood education programs.

The meeting will be held at: ___(Date and Time)___

Location:_________

The members of the Transition Planning Team are:

_________________________Parent*
_________________________EI Service Coordinator
_________________________Provider from the Family.s IFSP team
_________________________Receiving Agency Representative
_________________________Other

Please bring any necessary forms and materials to this Transition Planning Conference to assist you in:

Providing information to the parent(s) about all available educational programs for preschool children, including those programs for children with and without disabilities.
Providing information to the parents about the eligibility criteria for preschool special education services, including evaluation procedures and special education eligibility areas.
Providing the parents with an explanation of the requirements of a free appropriate public education (FAPE).
Providing the parents a copy of the procedural safeguards afforded the child and family as required in Part B of the IDEA.
Explaining the purpose of Extended School Year (ESY) services and the documentation needed to support the IEP team in determining eligibility for extended school year services.
Consent forms to conduct further evaluation to determine eligibility for preschool special education.
Other information needed to facilitate a timely, seamless transition.

If I can provide further information or if your schedule conflicts with the meeting date, please call.

___(EI Service Coordinator.s Name)___

___(EI Participating Agency)___

___(Phone Number)___

___(Date)___

* Parent means (1) a natural or adoptive parent of a child; (2) a guardian; (3) a person acting in the place of a parent (such as a relative or stepparent with whom the child lives, or a person who is legally responsible for the child.s welfare); or (4) a surrogate parent who has been assigned in accordance with relevant law. .Parent. does not include the State.

Example Transition Meeting Form Part II

Conference Summary Child.s Information:

Child.s Full Name (Last, First, Middle)
Date of Birth
Date of Transition Meeting
Child.s Address
City
State
Zip Code
Primary Language of Home
Limited English Proficient (yes/no)
Parents. * Names
Address
City
State
Zip Code
District of Residence (based on parent(s). address)
Participants in the Transition Meeting

Relationship to Child	Signature	Phone Number
Parent(s)*	___	___
EI Service Coordinator	___	___
Provider from the Family.s IFSP Team	___	___
Receiving Agency Representative	___	___
Other	___	___

Summary

Action Steps
Timeline
Person(s) Responsible

*Parent means (1) a natural or adoptive parent of a child; (2) a guardian; (3) a person acting in the place of a parent (such as a relative or stepparent with whom the child lives, or a person who is legally responsible for the child.s welfare); or (4) a surrogate parent who has been assigned in accordance with relevant law. .Parent. does not include the State.