Form CFS407-4 "Education Profile (Assessment)" - Illinois

What Is Form CFS407-4?

This is a legal form that was released by the Illinois Department of Children and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 1996;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CFS407-4 by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS407-4 "Education Profile (Assessment)" - Illinois

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State of Illinois
CFS 407-4
Department of Children and Family Services
Rev 10/96
EDUCATION PROFILE (ASSESSMENT)
INSTRUCTIONS: To be completed as part of the educational profile (assessment) process for all children for whom DCFS is legally
responsible who are placed in substitute care living arrangements. Reference evaluation reports which contain child specific areas of
concern suggesting referrals to and participation in preschool education or special education programs. Information contained in a
completed Education Report Form (CFS 407) should be used to complete this profile (assessment). Every item requires a response.
Indicate N/A where appropriate.
CHILD’S NAME:
DATE OF BIRTH:
I.
CHILD STATUS
1.
Has the child (preschool only) received a developmental evaluation?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding child's areas of strength and concern.
Document the actions taken:
2.
Has the child received a medical examination?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding the child's health status.
Document the actions taken:
3.
Has the child received a vision screening?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding the child's vision status.
Document the actions taken:
4.
Has the child received a hearing screening?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding the child's hearing status.
Document the actions taken:
State of Illinois
CFS 407-4
Department of Children and Family Services
Rev 10/96
EDUCATION PROFILE (ASSESSMENT)
INSTRUCTIONS: To be completed as part of the educational profile (assessment) process for all children for whom DCFS is legally
responsible who are placed in substitute care living arrangements. Reference evaluation reports which contain child specific areas of
concern suggesting referrals to and participation in preschool education or special education programs. Information contained in a
completed Education Report Form (CFS 407) should be used to complete this profile (assessment). Every item requires a response.
Indicate N/A where appropriate.
CHILD’S NAME:
DATE OF BIRTH:
I.
CHILD STATUS
1.
Has the child (preschool only) received a developmental evaluation?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding child's areas of strength and concern.
Document the actions taken:
2.
Has the child received a medical examination?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding the child's health status.
Document the actions taken:
3.
Has the child received a vision screening?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding the child's vision status.
Document the actions taken:
4.
Has the child received a hearing screening?
Yes
No
If yes, list date(s), evaluation(s) and findings regarding the child's hearing status.
Document the actions taken:
II.
INTERVIEWS
2
1.
Interview the child's classroom teacher and/or other school/preschool personnel. Review a completed CFS 407,
Education Report Form. Do comments or the report from school/preschool personnel identify:
a.
possible need for a special education case study or early intervention evaluation?
Yes
No
If yes, describe:
b.
disabilities or other conditions which might limit learning and other school/preschool achievement?
Yes
No
If yes, describe:
c.
specific abilities, talents, interests, and friendships that should be developed?
Yes
No
If yes, describe:
d.
how the child learns best?
Yes
No
If yes, describe:
e.
other areas of concern?
Yes
No
If yes, describe:
f.
any other information that will enhance the child's education? Yes
No
If yes, describe:
2.
Interview the child's biological parents (or adoptive parents if the immediate past placement was an adoptive home)
regarding the child's educational/developmental progress. Do the parents 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?
Yes
No
If yes, describe:
3.
Interview the foster parent(s) regarding the child's educational/developmental progress. 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? Yes
No
If yes, describe:
4.
Interview the child regarding his/her current school/preschool placement and performance. Does the child indicate any
specific abilities, interests, and friendships that should be developed or any areas of concern that may limit learning and
other school/preschool achievement? Yes
No
If yes, describe:
Child’s perspective regarding educational goals, achievements, frustrations, and friendships:
III.
EDUCATIONAL/DEVELOPMENTAL HISTORY
3
1.
Has the child ever been classified eligible for special education/early intervention (birth to three) services?
Yes
No
If yes, classification(s) given:
2.
Is the child currently eligible for special education/early intervention services?
Yes
No
3.
Is the child currently receiving special education/early intervention services?
Yes
No
4.
Does a review of past achievement/developmental test results show a decline in achievement/development over time?
Yes
No
5.
Does the child exhibit talents or academic behavior that indicate the need for accelerated instruction or placement
in a gifted program?
Yes
No
If yes, describe:
6.
Does the child exhibit behavior patterns in the area(s) of attitude, independence, organization, self-control, or social
interaction that indicates the need for intervention?
Yes
No
If yes, describe:
7.
List any additional educational or developmental needs and assets:
8.
List any needs for further assessment (including case study evaluation), school/preschool conference, tutoring, referral,
etc., that are indicated:
SUMMARY
Describe the overall educational/developmental status of the child and identify service needs, services being provided, and
plans to secure needed services currently not being provided:
Information from the CFS 407-4 Education Profile (Assessment) should be used to develop the Scholastic Summary Section of
the CFS 497 Client Service Plan.
Caseworker Signature
Date
Supervisor Signature
Date
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