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State of Illinois
Department of Human Services Guide for Families Illinois Early Intervention Program
July 2016www.DHS.state.IL.us
(800) 3234769Acknowledgments
The Early Intervention Clearinghouse
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How to fill out form illinois early intervention
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01
Start by downloading the Form Illinois Early Intervention from the official website.
02
Read the instructions carefully to understand the requirements and fill out the form accurately.
03
Provide your personal information such as name, address, phone number, and email.
04
Indicate the reason for seeking early intervention services in the designated section.
05
If applicable, provide details about your child including their name, date of birth, and any specific developmental concerns.
06
Fill out the medical history section, providing relevant information about your child's health and previous diagnoses, if any.
07
Include the contact information of your child's primary healthcare provider.
08
Sign and date the form to certify the accuracy of the information provided.
09
Make a copy of the completed form for your records.
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Submit the filled-out form by mail or through the online submission portal as instructed.
Who needs form illinois early intervention?
01
Any parent or legal guardian in Illinois who suspects their child may have developmental delays or disabilities can benefit from the Form Illinois Early Intervention.
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It is especially crucial for parents who want to access early intervention services for their child to fill out this form.
03
Childcare providers, healthcare professionals, or educators who have identified concerns about a child's development can also initiate the process by submitting this form.
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What is form illinois early intervention?
Form Illinois Early Intervention is a form used to determine eligibility for early intervention services in the state of Illinois for children under 3 years old who may have developmental delays or disabilities.
Who is required to file form illinois early intervention?
Parents or legal guardians of children under 3 years old who may have developmental delays or disabilities are required to file Form Illinois Early Intervention.
How to fill out form illinois early intervention?
Form Illinois Early Intervention can be filled out online or in person by providing information about the child's developmental concerns and medical history.
What is the purpose of form illinois early intervention?
The purpose of Form Illinois Early Intervention is to assess the child's eligibility for early intervention services and to develop an Individualized Family Service Plan (IFSP) for the child and their family.
What information must be reported on form illinois early intervention?
Information such as the child's medical history, developmental concerns, and family information must be reported on Form Illinois Early Intervention.
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