How can we help your child?

The information on this form will be received by the Early ACCESS, CART and Early Childhood teams. A service coordinator will contact you within the next week to talk about the next steps.

Is Your Child Zero to 2 Years, 10 Months Old?

⚠️ ATTENTION: All referrals for children ages zero to two years and 10 months must fill out THIS Form. All others will fill out the following. ⚠️ Suggested Browsers: Safari, Google Chrome, FireFox and Microsoft Edge.

Referral Form

Child's Home Address(Required)
Is this a referral for CART or Early Childhood services?
**CART — Rapid response team provides intensive behavioral support in childcare setting for children ages 0-5 who do not have special education needs. **Early Childhood — Concerns about the development of children between the ages of 3 and 5, not yet enrolled in school.
Has there been a previous evaluation done for this child?(Required)

Is an interpreter needed?
The parent or legal guardian has given consent to release this information to Grant Wood AEA(Required)
Max. file size: 64 MB.
This field is for validation purposes and should be left unchanged.