• Referrals

     

    School Age

    School Age Referral forms may be found on our District Forms page.

    Birth to 5 Years

    To qualify for services, a child must reside in Marion, Polk, or Yamhill Counties, and have a developmental delay or sensory impairment that meets the state eligibility guidelines related to one or more of the following areas:
    • Speech and language
    • Motor
    • Socialization
    • Behavior
    • Learning
    • Vision 
    • Hearing
    To schedule a free screening/evaluation, contact your local county specialist via the telephone numbers listed below.
     

    Marion County

     Sandra Gibson
    Sr. Clerical Specialist 
    Local: 503.385.4704
    Toll-free: 1.888.560.4666 Ext. 4704 
    Marion County Fax: 503.540.2959
     

    Polk-Yamhill Counties

    Talia Jimenez
    Sr. Clerical Specialist
    Local: 503.385.4714
    Toll-free: 1.888.560.4666 Ext. 4714
    Polk and Yamhill Counties Fax: 503.540.2958
     
     

    EI/ECSE Related Forms

    Online Referral Form (Health Care Providers: please use form above.)
     
    Child Development Screening Questionnaire: A screening designed to help parents check their child's developmental milestones: Checklist for Children Birth to 5 Years at asqoregon.com