Sample Letter #1 - How to Refer Your Child

(Insert date)
(Insert Official's Name)
(Street Address)
(City/State/Zip Code)

Dear (insert name of Early Intervention Official):

I would like to refer my child, (child's name), to the Early Intervention Program. My child is (age of child) and appears to have problems in his/her development. I understand that I will be contacted by a service coordinator who will explain the program to me and can help me choose an evaluator from a list that will be provided to me. I also understand that A Parent's Guide to the Early Intervention Program will be provided to me.

The best time to reach me is on (insert days and times)


(Insert Name)
(Street Address)
(City/State/Zip Code)
(Area Code/Phone #)

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