Project SEEK materials:
Notice to individual making the referral of family decision
to accept or refuse evaluation for eligibility determination, or inability
to contact family.
Colorful border around a form with spaces to record child identifying
information and boxes to check disposition of referral. Also includes
eligibility guidelines. Three designs available.
Cover page for sending evaluation results to Primary Care Physician
concerning a referral.
Includes request for input/communication from individual making
a referral; paragraph describing importance of early identification
and services; and (on reverse) list of risk factors for developmental
delay, by domain. Colorful border, three designs available.
Notice to individual making a referral confirming eligibility,
identifying service coordinator and inviting input to IFSP.
Three versions of Page 1: Version 1 includes brief description of
IFSP; Version 2 provides brief description of role of care coordinator;
Version 3 includes brief statement of reasons to refer children with
language delay. On reverse or second page of all versions, a fax cover
form and extra page for referring PCP to record input for IFSP, which
can be faxed to program. Three pages total per version.
To access these items, link to Project Seek’s website:
www.seek.hawaii.edu
More about this project
