Infant Toddler Program (ITP) Referral for Evaluation
Please complete this referral for evaluation if you have concerns about your child. A Family Resource Coordinator will reach out within two business days. Evaluations for Early Intervention are provided at no cost to your family. A team will assess your child’s development in the following areas:

-Cognitive: Problem solving, play, and thinking skills
-Communication: Using gestures, sounds, and words; understanding what others are saying
-Social/Emotional: Interacting with others and sharing feelings
-Physical: Using hands and eyes together to do things; rolling, sitting, crawling, walking, running, and jumping
-Self-Help/Adaptive: Calming, feeding, sleeping, and dressing

A child who presents with a delay in at least one area of development is eligible for Early Intervention services in Washington State.

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Child's Name *
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Parent/Guardian Name (2) *
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