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D45 Early Childhood Center Screening Request Form
To have your child participate in the District 45 Developmental Screening, please complete this form. Please answer all questions marked with an asterisk. This is the first step in the screening process for our programs.
Para la versión en español de este formulario, haga clic aquí.
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* Indicates required question
Email
*
Your answer
Is your child Male or Female?
*
Male
Female
Student Last Name
*
Your answer
Student First Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Student's Home Languages (Check all that apply.)
*
English
Spanish
Other:
Required
Student's Home School for K - 5 based on your current address
*
Choose
I don't know.
Ardmore
North
Schafer
Stevenson/York Center
Westmore
Phone Number (The best way to reach you.)
*
Your answer
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
You will be sent paperwork to fill out. It is available in English and Spanish. Please select your paperwork language preference.
*
English
Spanish
An ECC staff member will contact you to schedule your screening appointment at our next scheduled screening.
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