• DDI Vantage Early Head Start Referral Form

  • Date:
     - -
  • Referral Source:
  • Birth Date:
     - -
  • Expecting Mother:
  • Format: (000) 000-0000.
  • *Select all that apply:
  • Salt Lake Office (Taylorsville & Millcreek): 5287 South 4015 West, Taylorsville, UT 84129  Phone: (801) 966-0497

  • Tooele Office: 167 South Main Street, Tooele, Utah 84074  Phone: (435) 882-3439 

  • Should be Empty: