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Early Start Referral To Determine Appropriate Services For Infants and Toddlers who are Deaf or Hard of Hearing California Department of Education Deaf and Hard of Hearing Unit PLEASE TYPE OR PRINT

How to fill out early start referral form

How to fill out early start referral form

1. Obtain a copy of the early start referral form from the appropriate agency or website.
2. Read the instructions carefully to understand the information required.
3. Provide the child's personal information, including their name, date of birth, and contact details.
4. Specify any known medical conditions or developmental concerns of the child.
5. Include information about the child's current educational or therapeutic services, if applicable.
6. Provide details of the parents or guardians, including their names, addresses, and contact information.
7. Attach any supporting documents, such as medical reports or assessments, if necessary.
8. Review the completed form to ensure all sections are filled out accurately and completely.
9. Submit the form to the designated agency or address as specified in the instructions.
10. Follow up with the agency to confirm receipt and inquire about the next steps in the process.

Who needs early start referral form?

1. The early start referral form is needed by parents or legal guardians of a child who is suspected of having a developmental delay or disability. It is used to initiate the early intervention services provided by the early start program for children aged birth to three years.

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What is early start referral form?

Early start referral form is a document used to refer children with developmental delays or disabilities to the Early Start program for early intervention services.

Who is required to file early start referral form?

Parents, caregivers, healthcare providers, or educators can file the early start referral form on behalf of a child who may need early intervention services.

How to fill out early start referral form?

The early start referral form can be filled out online or by contacting the local Early Start program. The form will require information about the child's developmental concerns and contact information.

What is the purpose of early start referral form?

The purpose of the early start referral form is to identify children who may benefit from early intervention services to support their developmental needs.

What information must be reported on early start referral form?

The early start referral form will require information about the child's age, developmental concerns, medical history, and contact information of the child's parents or caregivers.