This form contains 146 fields organized into 27 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Abilities and Friendships to Develop
Yes	Checkbox	Check this box if the comments or report from school/preschool personnel identify specific abilities, talents, interests, and friendships that should be developed.
No	Checkbox	Check this box if the comments or report from school/preschool personnel do not identify specific abilities, talents, interests, and friendships that should be developed.
Abilities and Friendships to Develop - Line 1	Text	Enter the first line of the description regarding specific abilities, talents, interests, and friendships that should be developed. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Abilities and Friendships to Develop - Line 2	Text	Enter the second line of the description regarding specific abilities, talents, interests, and friendships that should be developed.
Achievement/Development Decline Review
Yes	Checkbox	Check this box if a review of past achievement or developmental test results indicates a decline over time.
No	Checkbox	Check this box if a review of past achievement or developmental test results does not indicate a decline over time.
Additional Educational or Developmental Needs and Assets
Additional Needs and Assets	Text	Provide a list of any additional educational or developmental needs and assets.
Behavioral Intervention Needs Assessment
Yes, needs intervention	Checkbox	Check this box if the child exhibits behavior patterns in attitude, independence, organization, self-control, or social interaction that indicate a need for intervention.
No, does not need intervention	Checkbox	Check this box if the child does not exhibit behavior patterns in attitude, independence, organization, self-control, or social interaction that indicate a need for intervention.
Behavioral Patterns Description Line 1	Text	Please provide the first line of the description for any behavioral patterns indicating a need for intervention. Fill only if 'Yes, needs intervention' is 'Yes'. Depends on: Yes, needs intervention
Behavioral Patterns Description Line 2	Text	Please provide the second line of the description for any behavioral patterns indicating a need for intervention. Fill only if 'Yes, needs intervention' is 'Yes'. Depends on: Yes, needs intervention
Caseworker Signature Date
Caseworker Signature Date	Date	Enter the date the caseworker signed the document.
Child's Information
Child's Name	Text	Provide the full name of the child.
Child's Date of Birth	Date	Provide the child's date of birth.
Child's Learning Style
Yes	Checkbox	Check this box if the school or preschool personnel identified how the child learns best.
No	Checkbox	Check this box if the school or preschool personnel did not identify how the child learns best.
Learning Style Description	Text	Enter a description of how the child learns best. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Learning Style Additional Description	Text	Provide any further details regarding how the child learns best.
Child's Perspective on Education
Child's Educational Perspective	Text	Provide a detailed account of the child's perspective regarding their educational goals, achievements, frustrations, and friendships. Fill only if 'Do the foster parent(s) identify any specific abilities, interests, and friendships that should be developed or any areas of concern that may limit learning and other school/preschool achievement?' is 'Yes'. Depends on: Yes
Child's School Achievement Details
Child indicates abilities/concerns - Yes	Checkbox	Check this box if the child indicates any specific abilities, interests, friendships that should be developed, or concerns that may limit learning and other school/preschool achievement. Fill only if 'Do the foster parent(s) identify any specific abilities, interests, and friendships that should be developed or any areas of concern that may limit learning and other school/preschool achievement?' is 'Yes'. Depends on: Yes
Child indicates abilities/concerns - No	Checkbox	Check this box if the child does not indicate any specific abilities, interests, friendships that should be developed, or concerns that may limit learning and other school/preschool achievement. Fill only if 'Do the foster parent(s) identify any specific abilities, interests, and friendships that should be developed or any areas of concern that may limit learning and other school/preschool achievement?' is 'Yes'. Depends on: Yes
Child's Interview Description	Text	Please describe any specific abilities, interests, friendships, or concerns indicated by the child that should be developed or may limit learning and school achievement. Fill only if 'Child indicates abilities/concerns - Yes' is 'Yes'. Depends on: Child indicates abilities/concerns - Yes
Child's Educational Perspective	Text	Please describe the child's perspective regarding their educational goals, achievements, frustrations, and friendships. Fill only if 'Child indicates abilities/concerns - Yes' is 'Yes'. Depends on: Child indicates abilities/concerns - Yes
Current Special Education Eligibility
Yes	Checkbox	Check this box if the child is currently eligible for special education/early intervention services.
No	Checkbox	Check this box if the child is not currently eligible for special education/early intervention services.
Current Special Education Services
Yes	Checkbox	Check this box if the child is currently receiving special education or early intervention services.
No	Checkbox	Check this box if the child is not currently receiving special education or early intervention services.
Developmental Evaluation
Yes	Checkbox	Check this box if the child (preschool only) has received a developmental evaluation.
No	Checkbox	Check this box if the child (preschool only) has not received a developmental evaluation.
Developmental Evaluation Details	Text	Provide the dates, specific evaluations, and findings concerning the child's developmental evaluation, including their areas of strength and concern. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Actions Taken	Text	Document the specific actions that were taken based on the developmental evaluation findings.
General
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Gifted Program Needs Assessment
Yes	Checkbox	Check this box if the child exhibits talents or academic behavior that indicates the need for accelerated instruction or placement in a gifted program.
No	Checkbox	Check this box if the child does not exhibit talents or academic behavior that indicates the need for accelerated instruction or placement in a gifted program.
Talents/Behavior Description Line 1	Text	Enter the first line of description detailing the child's talents or academic behaviors indicating a need for accelerated instruction or gifted program placement. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Talents/Behavior Description Continued	Text	Continue entering the detailed description of the child's talents or academic behaviors indicating a need for accelerated instruction or gifted program placement. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Hearing Screening
Yes	Checkbox	Check this box if the child has received a hearing screening.
No	Checkbox	Check this box if the child has not received a hearing screening.
Hearing Screening Findings	Text	Provide the date(s), evaluation(s), and findings related to the child's hearing status. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Hearing Screening Actions Taken	Text	Document the actions taken regarding the child's hearing screening.
Interview the child's biological parents
Yes	Checkbox	Check this box if the child's biological parents identified specific abilities, interests, friendships that should be developed, or any areas of concern that may limit learning or school/preschool achievement. Fill only if 'specific abilities, talents, interests, and friendships that should be developed?' is 'Yes'. Depends on: Yes
No	Checkbox	Check this box if the child's biological parents did not identify any specific abilities, interests, friendships that should be developed, or any areas of concern that may limit learning or school/preschool achievement. Fill only if 'specific abilities, talents, interests, and friendships that should be developed?' is 'Yes'. Depends on: Yes
Biological Parents Progress Description	Text	Please describe any specific abilities, interests, and friendships that should be developed or any areas of concern that may limit learning and other school/preschool achievement, as identified by the child's biological parents. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Biological Parents Progress Additional Description	Text	Please provide any additional details regarding specific abilities, interests, friendships, or areas of concern identified by the child's biological parents. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Interview the foster parent(s)
Yes	Checkbox	Check this box if the foster parent(s) identify any specific abilities, interests, and friendships that should be developed or any areas of concern that may limit learning and other school/preschool achievement.
No	Checkbox	Check this box if the foster parent(s) do not identify any specific abilities, interests, and friendships that should be developed or any areas of concern that may limit learning and other school/preschool achievement.
Foster Parent Interview Description Line 1	Text	Enter the foster parent's description of the child's educational/developmental progress, including any identified abilities, interests, friendships, or concerns that may limit learning or achievement. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Foster Parent Interview Description Line 2	Text	Continue entering the foster parent's description of the child's educational/developmental progress, including any identified abilities, interests, friendships, or concerns that may limit learning or achievement. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Learning Limiting Conditions
Yes	Checkbox	Check this box if disabilities or other conditions that might limit learning and school/preschool achievement are identified.
No	Checkbox	Check this box if no disabilities or other conditions that might limit learning and school/preschool achievement are identified.
Limiting Conditions Summary	Text	Summarize any disabilities or other conditions identified that might limit learning and school/preschool achievement. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Limiting Conditions Detailed Description	Text	Provide a detailed explanation of any disabilities or other conditions identified that might limit learning and school/preschool achievement, offering further insights or examples.
Medical Examination
Yes	Checkbox	Check this box if the child has received a medical examination.
No	Checkbox	Check this box if the child has not received a medical examination.
Medical Examination Findings	Text	Provide the date(s), evaluation(s), and findings regarding the child's health status from the medical examination. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Actions Taken	Text	Document the actions taken related to the child's medical examination.
Needs for Further Assessment
Further Assessment Needs	Text	Provide a list of any indicated needs for further assessment, such as case study evaluation, school/preschool conference, tutoring, or referral.
Other Areas of Concern
Yes, other areas of concern	Checkbox	Check this box if the interview with school/preschool personnel identifies other areas of concern.
No, other areas of concern	Checkbox	Check this box if the interview with school/preschool personnel does not identify any other areas of concern.
Other Areas of Concern Description	Text	Describe any other areas of concern related to the child. Fill only if 'Yes, other areas of concern' is 'Yes'. Depends on: Yes, other areas of concern
Other Areas of Concern Additional Description	Text	Provide additional details regarding other areas of concern related to the child.
Other Information to Enhance Education
Yes	Checkbox	Check this box if there is any other information that will enhance the child's education.
No	Checkbox	Check this box if there is no other information that will enhance the child's education.
Enhancement Information Summary	Text	Enter a summary of any other information that will enhance the child's education. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Enhancement Information Details	Text	Provide detailed information regarding any other information that will enhance the child's education.
Special Education Classification History
Ever Classified Eligible - Yes	Checkbox	Check this box if the child has ever been classified eligible for special education or early intervention (birth to three) services.
Ever Classified Eligible - No	Checkbox	Check this box if the child has never been classified eligible for special education or early intervention (birth to three) services.
Past Classification(s)	Text	Provide the classification(s) given if the child was previously eligible for special education or early intervention services. Fill only if 'Ever Classified Eligible - Yes' is 'Yes'. Depends on: Ever Classified Eligible - Yes
Past Classification Details	Text	Provide additional details or explanations regarding the child's past special education or early intervention classifications and services.
Special Education Evaluation Details
Yes	Checkbox	Check this box if comments or the report from school/preschool personnel identify a possible need for a special education case study or early intervention evaluation.
No	Checkbox	Check this box if comments or the report from school/preschool personnel do not identify a possible need for a special education case study or early intervention evaluation.
Special Education Need Description	Text	Enter the description if school or preschool personnel identified a possible need for a special education case study or early intervention evaluation. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Additional Evaluation Need Details	Text	Provide any additional details regarding the identified possible need for a special education case study or early intervention evaluation.
Summary
Educational/Developmental Status Summary	Text	Please provide a comprehensive summary of the child's overall educational and developmental status, including identified service needs, services currently being provided, and plans to secure any necessary services not yet in place.
Supervisor Signature Date
Supervisor Signature Date	Date	Provide the date when the supervisor signed the document.
Vision Screening
Yes	Checkbox	Check this box if the child has received a vision screening.
No	Checkbox	Check this box if the child has not received a vision screening.
Vision Screening Findings	Text	Provide the date(s) of vision screening, the evaluations conducted, and the findings regarding the child's vision status. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Vision Screening Actions Taken	Text	Document the actions taken following the child's vision screening.

CFS 431-1, Summary of the Child's Educational and Developmental Status Instructions