Get Soonerstart Early Intervention Program Referral Form - Ok.gov

Filling out the SoonerStart Early Intervention Program Referral Form is an important step in accessing early intervention services for children. This guide will provide clear and detailed instructions on how to complete the form online, ensuring that you have the necessary information at hand.

Follow the steps to effectively fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section 1, enter your child's information. Fill in the first name, middle initial, last name, date of birth, and age. Indicate if the child is in DHS custody and select their sex. Provide information related to ethnicity, including whether the child is Hispanic or Latino, and race by checking the appropriate boxes.
3. In Section 2, input family information. List the caregiver’s name, their relationship to the child, and contact details including cell phone and additional communication options. Provide the name and contact details of an additional person if necessary, and fill out the address, city, email, and county.
4. Also in Section 2, specify the native language and indicate if an interpreter is needed by checking the appropriate box.
5. In Section 3, explain the reason for the referral. Indicate if any supporting documentation is submitted and note this by checking 'YES' or 'NO'. Provide details about the referral source including name, title, agency, and address, and check whether parents are aware of the referral.
6. Complete the office use section with referral source email and phone, how the referral source heard about SoonerStart, and the date of referral. Fill in the name of the service coordinator, the date assigned, and the expected IFSP target date.
7. Once all sections are completed, you can save changes, download, print, or share the form as necessary.

Start filling out the SoonerStart Early Intervention Program Referral Form online today to ensure timely support for your child.