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  • Prince George’s Child Resource Center Project Win Release Form 2019

Get Prince George’s Child Resource Center Project Win Release Form 2019-2026

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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How to fill out the Prince George’s Child Resource Center Project WIN Release Form online

Filling out the Prince George's Child Resource Center Project WIN Release Form online is a straightforward process designed to streamline the collection of important information about your child. This guide will provide you with clear and supportive instructions to navigate the form easily.

Follow the steps to complete the form efficiently.

  1. Click the ‘Get Form’ button to download the form and open it in your preferred document editor.
  2. Enter the name of the parent or caregiver in the designated field. This identifies the individual completing the form.
  3. Provide the child's full name in the corresponding section. Ensure it matches the child's legal name for accurate documentation.
  4. Fill in the name of the service provider, which is the Maryland State Department of Education - Early Childhood Mental Health Project, as stated on the form.
  5. Include required information regarding the child's date of birth, gender, race, and ethnicity. Accurate entry is essential for the child’s records.
  6. Complete the section regarding developmental screening summaries and note if the child is receiving services under an Individualized Family Services Plan (IFSP) or an Individualized Education Plan (IEP).
  7. Review the authorization section, where you must grant permission for the collection and sharing of your child's information for program effectiveness tracking.
  8. Sign the document in the provided area, ensuring that you include the date of signing. Your signature confirms your agreement with the terms outlined in the form.
  9. Decide whether to print the form or save it electronically after review. Ensure you keep a copy for your records.

Begin filling out the Prince George's Child Resource Center Project WIN Release Form online today.

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This program is designed to address the social and emotional needs of children from birth to five years of age who are currently enrolled in licensed child care settings throughout Prince George's County. Project WIN promotes positive social and emotional development, which is a key to school readiness.

Project WIN services are FREE and include: Referral of children to community services, if needed. Workshops for parents and providers. Technical assistance services as needed.

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