Introductory Paragraph for the SEIT Report
1. What is the child's complete name?
2. What gender is the child?
Male
Female
3. Which positive adjective best describes the child?
Personable
Active
Curious
Friendly
Enthusiastic
Other:
4. What is the child's chronological age?
5. Is the child enrolled in a school?
Yes
No
6. What is the name of the school the child attends?
7. Where is the school located? (Borough & City)
8. What language(s) does the child speak?
English (Monolingual)
Bilingual
Other:
9. What is the SEIT mandate for the child?
10. When were SEIT services initiated with this provider?
11. Did the child receive SEIT services last year with a different provider?
Yes
No
12. If yes, when did services start with the previous provider?
13. What general issues are SEIT services addressing for this child?
14. Does the child receive any Related Services?
Yes
No
15. If yes, which Related Services does the child receive?
Speech Therapy (ST)
Occupational Therapy (OT)
Physical Therapy (PT)
Counseling (CO)
Other:
16. What is the Related Service Mandate?
17. When were the child's Related Services initiated?
18. What general issues are each Related Service addressing?
19. Indicate which, if any, Related Services have not been initiated as of this report?
20. What is the classroom teacher's statement regarding what happens when the SEIT is NOT present in the classroom to support the child?
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