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Early Intervention and Early Childhood Special Education referral information and forms


Assistive technology referral resources
  • Assistive technology referral form

Augmentative communication referral resources             
      
  • Augmentative communication referral form
  • Augmentative communication process flowchart
  • Augmentative communication equipment loan agreement: English and Spanish

Health, hearing and vision screening resources

  • Health screening questionnaire: English and Spanish
  • ​Hearing evaluation request
    • Form 30a (Coordinator must complete this form)​
      • IMPORTANT NOTE Regarding Form 30a:
        Clicking the link does not open the form. After you click the link you must download the form to see it.           
  • Hearing screening checklist: English and Spanish
  • Vision screening checklist: English and Spanish
  • Hearing test record form

Mental health assessment referral resources

  • Mental health assessment referral form (Sample Form)
  • Mental health focus
  • Which agency to refer to

Program review resources

  • Program review action planning form
  • Program review request form
  • Program review request guidelines​​
  • Program review request process

HILLSBORO OFFICE
503-614-1428
Fax: 503-614-1440
5825 NE Ray Circle
Hillsboro, OR 97124-6436

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ASTORIA OFFICE
503-325-2862
Fax: 503-325-1297
3194 Marine Drive
Astoria, OR 97103
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ST. HELENS OFFICE
503-366-4100
Fax: 503-397-0796
800 Port Avenue
St. Helens, OR 97051
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TILLAMOOK OFFICE
503-842-8423
Fax: 503-842-6272
2515 3rd Street
Tillamook, OR 97141
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