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MIDVALE SPECIAL EDUCATION COOPERATIVE Three Year/Intake /Initial Evaluation Checklist Student Name: A. Submit this checklist and the appropriate forms, as outlined below, to the Midvale Office. Check
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How to fill out three yearintake initial evaluation

How to fill out three year intake initial evaluation:
01
Begin by gathering all relevant documentation and information about the child, such as medical records, previous evaluations, and any relevant school or therapy reports.
02
Start the evaluation form by filling out basic information about the child, including their name, date of birth, address, and contact information.
03
Provide details about the child's family and household, such as parents' names, siblings, and any other caregivers involved in the child's life.
04
Next, fill in information about the child's medical history, including any past or current medical conditions, medications, and allergies.
05
Move on to documenting the child's developmental milestones, such as when they started walking, talking, and reaching other cognitive and physical milestones.
06
Provide information about the child's educational history, including previous school placements, special education services, and any Individualized Education Programs (IEPs) or 504 plans that may be in place.
07
Now, write about the child's social-emotional development, including any behavioral concerns or challenges they may be facing.
08
If applicable, document any specific concerns or observations about the child's speech and language development, fine and gross motor skills, sensory processing, or any other areas of development that may require attention.
09
Finally, conclude the initial evaluation by summarizing the child's strengths, weaknesses, and any specific recommendations for further assessments or interventions.
Who needs three year intake initial evaluation:
01
Children who are approaching their third birthday and may be eligible for Early Intervention services.
02
Children who have exhibited developmental delays or disabilities that require assessment and potential interventions.
03
Parents or caregivers who have concerns about the child's overall development and want to gather more information and support.
Note: The specific requirements for a three-year intake initial evaluation may vary depending on the region and the organization providing the services. It is always recommended to consult with professionals or agencies involved in early intervention to ensure accurate completion of the evaluation form.
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