"How Can We Connect You?"
Reasons to Contact us:
Diapers & wipes
Clothing & furniture
Food & formula assistance
Domestic violence, dental, mental health & medical provider referrals
Low-cost licensed childcare centers
Low-cost licensed homes
Free Early Head Start childcare center (0-3 year olds)
Pregnancy to Age 3 Support
Pregnancy support (WIC, MIHP, Early Head Start, 20 Hands referrals)
Age 0- 3 Support (WIC, MIHP, Early Head Start, 20 Hands, Early On referrals)
Preschool (3-5 year olds)
Low-Cost preschool classrooms (3-4 year olds)
Free Head Start classrooms (3-4 year olds)
Free GSRP classrooms (4 year olds)
Specific questions about your child's development.
Please state the specific question you have in our "What is your Question" box at the top of the referral form.
Agency representatives filling out forms on behalf of families.
*Referrals for Early On and GSRP require additional authorization from parents in order for us to share information back to the referring agency. Please send this form (coming soon) with parent's signature. Email the HM Team.
Update my Information
Agency or caregiver needing to update family information in the system.
Early On or Build Up Referral
Agencies making an Early On or Build Up referral for a child with possible developmental delay(s).
Please list the following information in our "Referral Notes" box at the top of the referral form.
Early On (age 0-3 years old) or Build Up (3-5 years old) referral
Specific reason for referral (i.e. communication, fine motor, gross motor, social, emotional, problem-solving concerns)
Best time of day we can contact you (Morning, Afternoon, Early Evening)
Any other information we should know about your family, like if your child had an IFSP or IEP.
Feel free to call us at (269) 512-7775