Get Mecp Parent Provider Referral Form - David Douglas School

Filling out the MECP Parent Provider Referral Form is an important step in accessing early childhood services for your child. This guide will provide you with clear, step-by-step instructions to complete the form efficiently and accurately online.

Follow the steps to fill out the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin with the child and parent contact information section. Fill in the child's name, birth date, and gender appropriately. Provide the names and contact information for the parent or guardian, including phone numbers, email address, and physical address. Make sure to specify the primary and secondary languages and indicate if an interpreter is needed.
3. Next, complete the child's ethnicity and race by selecting the applicable options. This includes checking whether the child is Hispanic or Latino and selecting any racial identities that apply.
4. In the consent for release of medical and educational information section, print the name of the parent or guardian. Provide the early childhood care and education provider’s name and the child's name. Finally, ensure that the parent or guardian signs and dates the consent form.
5. Proceed to the referral source and reason for referral section. Fill in the name and title of the provider making the referral along with the referral date. This section also requires the provider’s contact information and areas of concern. Be sure to check all applicable areas of concern and attach any completed screening tools.
6. Complete the community resources and birth to 5 services section. Enter the name of the birth to 5 provider and agency, and include relevant contact information. Specify the days and hours the child attends and indicate any DHS involvement if applicable.
7. Finally, fill out the referral results and follow-up section. Include requests from the referral source and any relevant eligibility information. Make sure to provide the dates for contacting the family and evaluating the child, along with the evaluation results.
8. After completing all sections, review the form for accuracy. Save your changes, download a copy, print it for your records, or share it as needed.

Start filling out your MECP Parent Provider Referral Form online today to access essential early childhood services.