30.F28 Sample Form Letter Text (pdf)

This text may be individualized for each child and family.

Sample 1: Ineligible - Initial Eligibility Determination

Dear (parent/guardian):

As we discussed, (child's name) has been found ineligible for Early Intervention because the comprehensive evaluation indicates that he/she is not currently exhibiting an eligible diagnosis, level of delay or risk condition. I am enclosing a Rights booklet, which explains your right to appeal this decision should you feel that to be necessary. Please review the Rights booklet at your earliest convenience.

If at any time prior to (child's name)'s third birthday you feel he/she should be re-evaluated by the Early Intervention system, you may again contact us at (CFC phone number). If you have questions or concerns about this decision, please contact me at (service coordinator phone number).

Sincerely,

Enclosure:

  • Rights Booklet
Updated: (06/07)