Head Start Early Childhood Screening and Other Data Request Form
Please complete the form to its entirety for faster response. Head Start does not release IEP/IFSP information; if you need that information then please contact the applicable School District.
Requester's Full Name
*
First Name
Last Name
Requester's Email Address
*
example@example.com
Requester's Organization
*
Relationship to the Child(ren)
*
Parent
Relative
School District
Charter School
Other
Please upload a signed release from Parent (if applicable))
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Early Childhood Screenings Requested for:
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