Okanogan County Early Head Start
0-3 Transition Plan/Family Partnership Agreement Form
Child Name: __________________________________ Birth date: _________________
Anticipated transition date out of Early Head Start: ________________________________
1304.41(c) To ensure the most appropriate placement and services, transition planning MUST start at least six
months prior to the child’s third birthday. The process must include:
1.
2.
3.
4.
Health status, including maintaining access to an ongoing source of medical care.
Developmental level, for the appropriate placement of the child.
Family progress in meeting family goals and strategies for continuing to meet ongoing or newly identified
goals.
Availability of Head Start and other child development or child care services.
18 Months:
(only for areas of Oro,
Ton,Omak, and Brew)
Discuss program option for continuing EHS services (check the option the
parent would like):
o Continued home base with weekly home visits, or
o Transition into Combo class with 2 days of class and 2 home
visits per month
Date: ________

Parent Initial: _______
Review preschool readiness checklist
From preschool readiness checklist and family transition menu –
establish plan for child and family to be ready to transition into Combo
or continued home based services - (FPA) Child and family goals
working on to prepare child and family for next placement. Coordination
with other agencies involved:
FCE Initials: _______
Transition from Home
Base to Combo class
Date: ________
Parent Initial: _______
FCE Initials: _______
FCE and family meet with staff from the Combo class that the child is
preparing to transition into.
 Review preschool readiness checklist, goals working on,
assessment, and needs of the child and family to determine the
individualized transition plan and timeline of center placement.
From preschool readiness checklist, family transition menu, and
meeting with Combo Teachers– establish plan for child and family to be
ready to transition into Combo(FPA) Child and family goals working on
to prepare child and family for next placement. Coordination with other
agencies involved including Combo teachers:
Plan for transition of child and family to Combo teacher’s caseload:
Ensure child’s health status is current:
[ ] Status of child’s well child exam schedule
______________
[ ] Status of child’s immunizations
______________
By signing below I agree that as the parent/guardian, I am in agreement with my child’s
transition into the EHS combo class. I agree that my child is developmentally ready to be in a
classroom with children who are approximately 2 ½ to 3 years (according to each child’s transition
plan).
___________________________
Parent Signature
__________________________
Date
Date of transition into Combo: ________________________
30 Months:
(all children in all areas)
Date: ___________
(i.e. Head
Start/ECEAP, EPIC, Child Care, Community Preschool, School District Developmental
Preschool, Montessori)

Program Selection/Comments:

Discuss income eligibility for Head Start or ECEAP placement
o Family meets HS income guidelines?
Parent Initials: ________
FCE Initials: _________
 Appropriate application filled out and given to appropriate party:
(Head Start/ECEAP application also includes proof of income and birth)
Date completed application turned in: ____________

Review preschool readiness checklist
From preschool readiness checklist and family transition menu –
(FPA) Child and family goals working on to prepare child and family for
next placement. Coordination with other agencies involved:
33 Months or 3 months prior to transition out of EHS:
 Review preschool readiness checklist
m the program
that has been selected to review preschool readiness checklist, goals
working on, assessment, and needs of the child and family to determine
the individualized transition plan and timeline of center placement.
Date: ________

Program Selected:

Participants:

Plan Outline:
Parent Initials: _________
FCE Initials: __________
In coordination with next placement and other agencies involved,
identified goals and individual transition plan for preparation of child
and family for next placement:
36 Months or prior to transition:
needs are discussed with
family
Date completed or status of:
[ ]
Child’s 3-year well child exam
______________
[ ] Child’s immunizations
______________
[ ] Child’s dental exam
______________
[ ] ASQ-3 screening
______________
Date: ________
plan.
Parent Initials: ________
FCE Initials: __________
Anticipated Start Date: ________________________

Review preschool readiness checklist

Recommended support for transitioning child ( i.e. goals working
on, strategies to use):

FCE and family celebrate the work that has been done together.

If transitioning to Head Start or ECEAP, pre-existing plans the
child/family will continue to be involved with at next
placement:
Okanogan County Early Head Start
Preschool Readiness Checklist
Physical Health
_____ Sits at mealtime with others
_____ Use eating utensils appropriately
_____ Able to pour
_____ Feeds self
_____ Drinks from a cup
_____ Wipe own nose with assistance
_____ Wipe own nose independently
_____ Demonstrates awareness of body space
_____ Uses playground equipment appropriately with safety
_____ Actively participates in new activities
_____ Plays with materials of different textures
_____ Has experience holding and using markers, crayons, pencils, paints, etc.
_____ Opens and closes blunt scissors
_____ Read a book – treats books with respect
_____ Works simple puzzles
_____ Indicates when he/she is wet or soiled
_____ Takes care of toilet needs with adult assistance
_____ Takes care of toilet needs independently
_____ Tells an adult when he/she is hurt
_____ Communicates feelings such as “I don’t feel well,” “He hurt me,” “I’m hungry,” etc.
_____ Sits using appropriate child restraint during bus transport
Comments:
Social-Emotional Development
_____ Form an attachment with someone other than the primary caregiver
_____ Able to separate from primary caregiver
_____ Indicates preferences by yes or no answers
_____ Follow family routines
_____ Plays in the presence of other children
_____ Occupies self for a brief time
_____ Makes choices
_____ Plays side by side with another child, at times
_____
_____
_____
_____
Takes turns (controlled game) play, with assistance
Learn consequences of specific behavior
Explore and play in a range of familiar settings
Notice other children who are happy or sad
_____ Identifies gender, similarities and differences in self and others
_____ Anticipate and follows simple routines and rules
_____ Begins to control impulses
Comments:
Approaches to Learning
_____ Inquisitive (asks questions – why? how?)
_____ Curious about how things work
_____ Able to dress/undress – willing to try
_____ Builds on open ended questions
Comments:
Cognition/General Knowledge
_____ Uses objects as intended
_____ Begins make-believe play
_____ Chooses between 2 choices
_____ Can communicate needs/wants
_____ Sings simple rhyming songs
_____ Fills and empties containers
_____ Identifies 2 shapes
_____ Uses 5 senses
_____ Notices animals, plants, and people in the environment
_____ Understands and uses prepositions
_____ Shares and takes turns
_____ Knows where to put trash
Comments:
Language/Literacy/Communication
_____ Interacts during circle, story time, etc.
_____ Sits through a 5 minute song or story
_____ Learns a song, game or story used in next placement
_____ Expresses wants/needs using gestures
_____ Expresses wants/needs using 3-4 word sentences
_____ Uses prepositions
_____ Follows 1 step directions
_____ Follows 2-3 step directions
Comments: