Request edit access
Child Find Order Form
This form allows you to order Child Find Materials and submit your request online directly to Belinda Fox at CESA 6.
Shipping is not covered by grant funding. Materials will be delivered to your local CESA office. Delivery can take 2-4 weeks.
Child Find Materials funded by: Wisconsin Department of Public Instruction IDEA Preschool Discretionary Grant 2016-14-74-9906-70.
Your full name:
Your answer
School District/Agency:
Your answer
Which CESA serves you?
Address - include: City, State & Zip
Your answer
Your email address:
Your answer
Your phone number w/ ext:
Your answer
Date you need materials by:
Your answer
Child Find Tri-fold Brochure - includes developmental milestones, Child Find definitions, legal references and web resources for families. Space for school district label on back.
Child Find Brochure
I need # Brochures
Your answer
Child Find Pen - Blue pen/black ink w/ silver Child Find imprinted with logo & 'Finding Children with Special Needs'.
Child Find Pen
I need # Pens
Your answer
Child Find Lined Sticky Note Pad - 4"x6" imprinted with logo & 'Concerned about a child's development? Contact your local school district.'
Child Find Note Pad
I need # Note Pads
Your answer
Child Find Adhesive Bandage Dispenser - contains 4 with space for school district label/phone number on reverse.
Child Find Bandaids
I need # Bandage Dispensers
Your answer
Child Find 12"x16" Bag - white plastic bag w/ handle imprinted with logo
Child Find Bag
I need # bags
Your answer
Child Find Brochure for SCHOOL DISTRICT PERSONNEL ONLY - contains information for Child Find Requirements
Brochure for School District Personnel only
I need # School District Brochures
Your answer
For questions please contact:
Belinda Fox at CESA 6 via Email at bfox@cesa6.org or Phone: 920-236-0576
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of CESA5. Report Abuse - Terms of Service - Additional Terms