Early Childhood Services Request Form

Thank you for your interest in Minneapolis Public Schools (MPS) Early Childhood Education. Please complete this form so we can reach out to you. MPS will use this data to connect families to MPS early childhood services. Thank you!
Parent/Caregiver*

First NameLast Name
Phone Number*
To call or textFormat: (000) 000-0000.
Email
Preferred Language*
Interpreter*

YesNo
Ages of Children*

Prenatal0-1 years2-3 years4-5 years6-8 yearsOther
Click on the service you're most interested in. A staff member from the program will contact you with more information.*

Early Childhood Family Education (ECFE) - Get more information on weekly classes, Home Visit, or ask a parenting question.ECS- Schedule an Early Childhood Screening appointment. (Age 3-6 only)Get more information on Three School, High Five, and Kindergarten.Teen Parent Services (TPS) - To learn what resources are available to teen parents.Birth-5 Central-Early Intervention - identified with a speech/language or developmental delay (Early Childhood Special Education)
Are you a Minneapolis resident?*

YesNo
Would you like to request an evaluation now, or would you prefer to have someone contact you to share more information first?

I’m ready to request an evaluation.I’d like someone to contact me with more information first.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide child's name and birthdate. To add additional children, click "Add Row"*
Who is submitting this interest form?*

SelfFamily or Friend of the Parent or CaregiverClinic or Hospital Staff/Public Health NurseMPS StaffOther
Contact Information*
Name of person completing this form:*
Is there any additional information about the family that will help us better support them? *
Should be Empty: