Get Child Find Fdlrs Referral Form 0-5 - Centerforchildwelfare

Filling out the Child Find FDLRS Referral Form for children ages birth to five is an essential step in ensuring that young children receive the appropriate services and support. This guide provides a clear and detailed walkthrough of how to complete the form online, ensuring accuracy and ease of submission.

Follow the steps to successfully complete the referral form.

1. Click ‘Get Form’ button to access the Child Find FDLRS Referral Form, which will open for you to begin filling it out online.
2. In the 'Information Received By' section, enter the name of the individual processing the referral, along with the date and unique FDLRS number.
3. Provide your information in the 'Referred By' section, including your name, phone number, email address, relationship to the child, and the name of your agency.
4. Indicate whether the referring source is a child protection agency or a CSC-funded family strengthening program by selecting 'Y' for yes or 'N' for no in the respective checkboxes.
5. Fill in the child's name, date of birth (DOB), and notation if the child is currently receiving protective services, along with the agency providing those services.
6. Select the child’s sex by checking the appropriate box (M for male, F for female) and fill in the primary language spoken at home.
7. Indicate the child's age and whether they are currently enrolled in subsidized childcare by checking 'Y' for yes or 'N' for no in the respective checkbox.
8. Detail the home address, including the apartment number, city, state, and zip code, along with your home and work phone numbers.
9. Provide the name and relationship of an alternative contact, along with their phone number, noting if the child is covered by healthcare insurance.
10. List any developmental or educational concerns the child may have by checking relevant boxes including communication, motor skills, cognitive issues, and more.
11. Indicate whether the child is currently receiving developmental services for specific therapies and include additional comments as necessary.
12. Once all sections are completed, review the form for accuracy. You can save changes, download, print, or share the completed form as needed.

Begin the process of filling out the Child Find FDLRS Referral Form online to help young children receive the support they need.