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Get Prince George’s Child Resource Center Project WIN Release Form 2019-2024

AUTHORIZATION FOR RELEASE OF INFORMATION Parent or Caregiver Name: Child s Name: Provider/Covered Entity: Maryland State Department of Education - Early Childhood Mental Health Project Service Provider. Project WIN (Wise Intervention Now) Requestors: The Early Childhood Mental Health Project (ECMH) is funded through the Maryland State Department of Education (MSDE). MSDE is requesting that all of its ECMH grantee programs collect.

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