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CHILD
Children ages 3 - 5 years old
This process is not intended for students entering Kindergarten.
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Email
*
Your email
Child's full name
*
Your answer
Child's date of birth
*
MM
/
DD
/
YYYY
Parent/Guardian's Name
*
Your answer
Phone Number
*
Your answer
Please tell us about your concerns for your child
(speech, language, hearing, vision, behavior, developmental milestones, etc)
*
Your answer
If your child has been evaluated or diagnosed by your family doctor, pediatrician or other professional agency, please share their name and diagnosis.
Your answer
Thank you for sharing your child's information with us. We will contact you to set up a time to screen your child. If you have any questions, feel free to contact Tammy McCurley at 731-686-0840 or mccurleyt@milanssd.org.
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