Resources / FAQ – Welcome to Leap Ahead Services

Resources / FAQ

Home / Resources / FAQ

Early Intervention Forms & Resources

Access the forms and resources you need to support your child’s early development.

Individual Session Note Version 1

Individual Session Note Version 2

Assignment and Change in Service, Service Provider, Service Coordinator (Fillable PDF)

NYC EIP Session Note Version 2 (updated 2026)

NYCEI Break In Service Form New (10.15.19)

NYC EIP Provider Progress Note

NYC Justification Form for Change in Services

NYC Request for Additional Evaluation

Parental Consent for Evaluation Form

Team Meeting Results / Attendance Sheet

NYC Assistive Technology Medical Necessity Justification Form

NEW Session Signature Log (In-Person and Telehealth) – updated Aug 2024

Early Intervention Forms & Resources

Access the forms and resources you need to support your child’s early development.

Procedures

Citations for Self-Assessment Tool:

Assignment and Change in Service, Service Provider, Service Coordinator (Fillable PDF)

Assistive Technology Information Exchange Form (Fillable PDF)

Closure Form (Fillable PDF)

Consent for Additional Evaluation (Fillable PDF)

Consent for Evaluation or Screening (PDF)

Consent Form for Transition Conference (Fillable PDF)

Consent Form for Transmittal of EIP Evaluations and Records to the Committee on Preschool Special Education (Fillable PDF)

Consent to Obtain and Release Information (PDF)

Evaluation Agency MDE and Screening Submission Checklist (PDF)

Family Concerns, Priorities, and Resources (PDF)

Foster Care Surrogacy Recommendation and EIOD Assignment (PDF)

Functional Outcomes Assistant and Instructions (PDF)

Group Session Note Version 1 (Fillable PDF)

Group Session Note Version 2 (Fillable PDF)

IFSP Meeting Consent for Services (Fillable PDF)

IFSP Scheduling Forms

Initial Service Coordination Consents (PDF)

Initial Service Coordination Duration, Unit or Assignment Change (PDF)

Justification for Change in Frequency Intensity or Length of Services (Fillable PDF)

Multidisciplinary Evaluation Summary (PDF)

Notice of IFSP Meeting (Fillable PDF)

Notification of AT Item Delivery w/Instructions (Fillable PDF)

Notification to Foster Care Agency of Transition Out of Early Intervention (Fillable PDF)

Notification of Potential Eligibility to CPSE (Fillable PDF)

NYCEIP AT Medical Necessity Justification Form with Instructions (Fillable PDF)

Parent Designation of Person Acting in Place of Parent (PDF)

Parent Form: Written Notification and Written Opt-Out Requirements and Timeline (Fillable PDF)

Parent Referral to CPSE (Fillable PDF)

Progress Note (Fillable PDF)

Reason for Delay in Evaluation Completion and MDE Submission (PDF)

Reassignment or Termination of Surrogacy (PDF)

Request for Additional Evaluation (Fillable PDF)

Request for County and Borough Transfer (Fillable PDF)

Request for Foster Care Surrogacy Determination Letter (PDF)

Request for Mediation and Parental Consent to Release Information (Fillable PDF)

Request for Sign Language Interpreter (PDF)

Screening Summary (PDF)

Service Log (Fillable PDF)

Individual Session Note Version 1 (Fillable PDF)

Individual Session Note Version 2 (Fillable PDF)

Status of Start Date of Services (Fillable PDF)

Steps Taken to Determine Need for Surrogate Parent (PDF)

Your Family Rights in Early Intervention (PDF)

Other Languages:

Additional Resources

Other Languages: