Southern Kennebec Child Development Corp
Southern Kennebec Child Development Corp.
CHILD TRANSITION SUMMARY AND CHECKLIST
Child Name: ______DOB: ______Current Center: ______Town Residence: ______
Legal Parent/Guardian(s) Name(s): ______Bio and/or Foster Parent(s): ______
Current Teacher/Home Visitor: ______Current FSC/Case Manager: ______
Request for Transfer or HS Transition (completed by Teacher/Home Visitor and reviewed with Supervisor)
o Center/Program requested: ______Reason: ______
o (For EHS to HS) Head Start application and eligibility complete at 2.5 yo and submitted to ERSEA Manager, Kathy B
o (For EHS to HS) CFHH and Nutrition Screening are only done annually, NOT at chronological age. Date last done:______
o ESI-P, ASQ-SE, Vision and Hearing to be complete when the child is chronologically 3 years old.
o Vision, hearing, developmental screening up to date? ______Date of last WCC? ______Date of Dental exam?______
o Date of Last File Review ______
o If child care is requested, what is CC Subsidy and work/school schedule? ______
o Does family have transportation? ______Does family have challenges with attendance? ______
o Does child have health conditions; IHP or NAP? ______
o Does the child have disability, special services or medical model therapy? ______Next IEP/IFSP? ______
o Is Maine Care/Insurance # in ChildPlus? ______
o Are any additional screenings or observations or D/MH manager approval needed prior to transition? ______
o Are there any classroom modifications or accommodations in use or needed? ______
o Will the receiving staff need training for Health/Nutrition plans or Disability services? ______
o What other agencies are involved with child and family? ______
o What is status of referrals for child and/or family? ______
o Is case management in place or needed? ______
o Have you discussed process for transition with parent(s)? Is more information needed? ______
Plan for Follow-up
TASK / WHO / DUE DATE______
Teacher/Home Visitor Signature Date Center Supervisor Signature Date
[Center Supervisor reviews, signs and forwards to ERSEA Manager, Kathy B.]
Approved by ERSEA Manager ______Date ______Approved by Program Manager ______Date ______
Approved by Disb/MH Manager ______Date ______Approved by Health/Nutrition Manager ______Date ______
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REVISED October 2017