DOCUMENTATION OF APPROPRIATE INSTRUCTION - PRESCHOOL	

STUDENT’S NAME: _________________________DATE:_______________________

CHECK ALL ITEMS THAT APPLY TO THE STUDENT.

___ 	The student is currently attending a preschool program for nondisabled ________ year old         	children.

How long has the student attended this preschool program? _______months/years

___ 	The student is currently attending a preschool program and has access to a research based curriculum by a highly qualified teacher.  

How long has the student attended this preschool program? _______months/years

___ 	The student attends a certified daycare program.

	How long has the student attended this certified daycare program? _______months/years

___ 	The student attends a home daycare program. 
	
	How long has the student attended this home daycare program? _______months/years  
 
___ 	Parent reports the student has had access to age appropriate activities for a 	preschooler such as:  play dates with peers, Sunday school class, story time at the public library.  
      
___	The student has received instruction and/or therapy through Early Intervention.

___ 	The student has received private speech therapy services.

___ 	The student has the opportunity to participate in age-appropriate activities through        	interactions with peers and siblings.

___ 	The parent reports that he/she reads to the student daily.

___	The parent reports that the child has progressed according to research based developmental normative charts.

___	Other   _________________________________________________________________________

_______________________________________________________________________________

Name of person completing this form: ____________________________________________________