Early On Referral

Thank you for contacting Early On of St. Clair County. The information that is provided will be kept confidential. Within 10 calendar days. the family will be contacted by a local Early On staff member from the local school district. 

 

If you have questions about the online referral process, please call (810) 455-4398 or send an email.

Early On Referral Form

Early On referral form
Referral Form
Pediatrician
Hospital
Department of Human Services
Teacher/Educational Professional
Childcare Provider
Family Member
Website
Advertisement
Other
Child's Information
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  ?
Male
Female
Yes
No
 
Parent/Legal Guardian Information
Birth Parent
Adoptive Parent
Foster Parent
Legal Guardian
Other
In order to send this referral on to the appropriate agency, we need an address. If the child and/or parent does not have a permanent address, please call 1-800-EarlyOn to make the referral.
 
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Yes
No
Your Contact Information
 
Yes
No
 
Yes
No