Get Eip Sample Form

Completing the Eip Sample Form online is an important step in ensuring that your child receives the necessary evaluations and services. This guide will provide you with clear, step-by-step instructions on how to fill out the form accurately and effectively.

Follow the steps to complete the Eip Sample Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred browser.
2. Enter the date in the designated field at the top of the form.
3. Fill in your child’s name in the fields provided, including last and first names.
4. Input your child's Early Intervention (EI) number in the specified field.
5. Provide a phone number where you can be reached for any follow-up.
6. Complete the ‘Name of Parent/Legal Guardian’ section with your last and first names.
7. Fill in your home address to ensure proper correspondence.
8. Indicate the school district in which your child resides.
9. Enter the name of your service coordinator along with their contact number.
10. Provide the name of the Early Intervention official or designee and their phone number.
11. Fill in the name and phone number of the CPSE chair.
12. Read the consent section carefully to understand your rights regarding the sharing of evaluations and records.
13. Choose whether to consent to the transmission of EIP evaluation and program records to the CPSE by checking the appropriate box.
14. Sign your name in the designated area as the parent or legal guardian.
15. Date your signature to complete the form.
16. Review the completed form to ensure all fields are accurately filled before saving, downloading, printing, or sharing the document.

Complete your Eip Sample Form online today to ensure your child receives the support they need.