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Department of Economic Security       Arizona Early Intervention Program (AzEIP) Public Awareness Materials Order Form
Thank you for your interest in ordering AzEIP public awareness material. 

Please complete this ordering form to receive FREE copies of the brochures for your agency/ organization within the state of Arizona. Items will be shipped at no cost to you. 

Please note Section 2 is for English brochures and Section 4 is for Spanish brochures.  The poster is two-sided in both languages.  To view the brochure- click the Open Brochure View link beside each title. 

Please allow 10 business days for your order to be processed.  You will receive an email when your order has been shipped or if an item is on back order.  

If you have any questions, please contact the AzEIP team at (602) 532-9960 or azeip@azdes.gov.  Thank you!
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Email *
Requestor's First & Last Name 
Agency/Program Name
State of Arizona Mail Drop (if applicable)
State Agencies Only: Address fields below are not needed if Mail Drop is provided
Mailing Address
Number and Street Address
City
State
Zip Code
In what county will these materials be used?  
Please check all that apply
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How did you learn about the AzEIP public awareness materials? *
Who is the audience for the brochures? *
Required
Do you want to order public materials in English and Spanish or Spanish only? *
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