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Early Childhood Screening Request

If you have a child between the ages of 3 and 5 and would like to request a screening for early childhood services in our district, please complete the screening request below.

Early Childhood Screening Request

Required

Parent/Guardian Namerequired
First Name
Last Name
Child Namerequired
First Name
Last Name
Must contain a date in M/D/YYYY format
Single Child is...required
Best way to contact you:required
Do you need a translator?required