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Madison Metropolitan School District

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Early Childhood Request for Assistance - Child Find

Child Find Developmental Screening will resume in September for the 2022-23 school year.

This form is for preschool children within the Madison Metropolitan School District.

The first step in this process is gathering information about the child by filling out the form below. This information is important for us to have whether you would like a Child Find screening or are making a referral for Special Education. It is essential that you make every effort to provide detailed information in the request form.

If we do not receive detailed information, an email will direct you to resubmit your request for assistance.

Private/Parochial

If you are the parent of a child enrolled at a private/parochial school within Madison, you may contact your child's teacher or school administrator for intervention information. Check the MMSD Private/Parochial webpage for more information.

Call the Information Line at (608) 663-8471 if you need assistance in completing the form and when making an immediate referral to evaluate your child for Special Education.

Special Education Evaluation

If you feel your child may have a disability and you feel an immediate need for a special education evaluation, complete the "Early Childhood Request for Assistance" form below AND call the Child Find Line to request an evaluation at (608) 663-8471.

Required

Child's Information

Namerequired
First Name
Last Name
Date of Birthrequired
Must contain a date in M/D/YYYY format
Genderrequired
Is this child Hispanic or Latino?required
Select one or more of the following categories that apply to this studentrequired
Primary Languagerequired
Other Languages Spoken in the Homerequired
On weekdays the child is atrequired(Check all that apply)
(Check all that apply)
If you checked "Other" above, please describerequired
Please indicate child's Monday through Friday schedule and locationrequired

Parent / Guardian Information

Namerequired
First Name
Last Name
Street Addressrequired
Cityrequired
Zipcoderequired
Home Phonerequired
Cell Phone
Please indicate the best time to call you between 8:00 am and 4:00 pmrequired
Email Address
Is this child involved in the foster care system or have other considerations regarding custody or educational decision-making we should be aware of?required
If you answered yes above, please explainrequired
School Attendance Arearequired
Does the child spends time at 2 different households?required

2nd Parent / Guardian Information (if applicable)

Since the child spends time at 2 different households, please enter the information for the second household here.

Namerequired
First Name
Last Name
Street Addressrequired
Cityrequired
Zipcode
Home Phonerequired
Cell Phone
Please indicate the best time to call you between 8:00 am and 4:00 pmrequired
Email Address
School Attendance Arearequired

Information About Person Making Request

Namerequired
First Name
Last Name
Relationship to Child
How long have you known this child?required
If you checked "Other", please describe your relationship with the child and how you notified the parent of the requestrequired
If parent/guardian is making this request (and child attends preschool/childcare), when and how was the child's teacher and director notified of this request?
Do parent(s) / guardian(s) give permission for school staff to observe the child if necessary in the weekday settings listed above?required

Childcare / Preschool Information (if applicable)

Name of Childcare / Preschool Center
Address
Phone
Email Address
Teacher Name(s)

Child Concerns & Information

Please provide a short description of child (likes, interests, strengths)required
This request is for concerns in the area(s) ofrequired(check all that apply)
(check all that apply)
For each item checked above, provide a detailed description of the concernrequired
Give specific examples of what the concern looks like in childcare, home or community settingsrequired
Describe what you have tried to address the concerns above. Include a description of the intervention and the length of time these interventions were in placerequired
Has your child had an evaluation in any area of development(check all that apply)
(check all that apply)

For each item checked above, please email reports to idearecords@madison.k12.wi.us - Attn Records Manager.

Does your child have a diagnosis of any kind?
Is your child on any medications that you think we should be aware of?
After you have submitted your request and it has been processed, you will receive followup paperwork in the mail. This paperwork will be sent to the child's family.