30.F14 Sample Form Letter Text (pdf)
This text may be individualized for each child and family.
(Child's name) was recently referred to Child and Family Connections by (referral source) because of concerns with his/her (adaptive/cognitive/communication/motor/ social-emotional development. Child and Family Connections is the regional system point
of entry for the state's Early Intervention Services System. Early Intervention provides services and supports to infants and toddlers with developmental concerns and their families. Participation is voluntary.
I have not been able to contact you by phone. Please contact me in the next 10-days to let me know if you are interested in moving forward with this referral. I can be reached at (service coordinator phone number), or you can return this letter in the
enclosed envelope. I look forward to hearing from you.
- Informational Brochure(s)
- Rights Booklet
Check one and return in the enclosed envelope if unable to contact me by phone:
- Please call me at this number: ______________, at this time: ______________ to discuss this further.
- I am not interested at this time.