Early Intervention Intake

Brandywine School District Child Find Referral

FOR DELAWARE RESIDENTS ONLY

Child Find is a federally funded initiative in Delaware designed to locate, identify, and support children and youth ages 0–21 who may need educational services and are not currently attending public school. In the Brandywine School District, the Child Find team provides developmental screenings, evaluations, and service recommendations for both preschool-aged and school-aged children.

If you have concerns about your child’s development—whether related to speech, movement, learning, or social interaction—you are not alone. Many families have questions about developmental milestones and wonder if their child is progressing as expected. The CDC’s Developmental Milestones resource is available below to help guide families as they consider their child’s development.

Brandywine School District also offers Early Intervention services for preschool-aged children (ages 3 through kindergarten entry) who may benefit from additional support. Identifying concerns early and providing services when needed can help children build important skills for success in school and beyond. Before completing this referral, please click here to confirm that your home address and/or child care center is within the Brandywine School District feeder pattern.

Please note: if you are currently receiving services through BIRTH TO THREE PROGRAM please complete this form. Do NOT complete the form below.

For questions, please contact ChildFind@bsd.k12.de.us

Referral Information

Child's Full Namerequired

First Name

Middle (optional)

Last Name

Child's Date of Birthrequired

Must contain a date in MM/DD/YYYY format

Child's Genderrequired

Male

Female

Non-binary

Prefer not to say

Indicate the child's race below. At least one race must be selected, regardless of ethnicity. required

Child's primary residential address:

Street (Example: 123 Main Street)required

Cityrequired

Staterequired

Zip Coderequired

Insert and format text, links, and images here

Parent's/guardian's full name:required

First Name

Last Name

Parent's/guardian's phone number: required

Parent's/guardian's email address:required

Primary language of the family and child:required

Is an interpreter needed for communication with the family?

Yes

No

Child's Primary Medical Provider Information

Primary Medical Provider Name

Prefix

First Name

Last Name

Primary Medical Provider Phone Number

Primary Medical Provider Email Address

Primary Medical Provider Address

Parent Input and Developmental Concerns

Please use this section to tell us about your child and the concerns that led you to request a Child Find referral. Families often notice differences in speech, movement, learning, behavior, or social interaction. Sharing your observations helps our team better understand your child’s needs.

Has your child ever received services such as; an Individualized Education Program (IEP), an Individualized Family Service Plan (IFSP), speech therapy, occupational therapy, or physical therapy (now or in the past)? If yes, please indicate which services they received. required

Which areas of your child's development do you believe may be delayed?required

Articulation: Difficulty pronouncing sounds or being understood when speaking

Communication (receptive or expressive): Challenges understanding language, following directions, or using words and sentences to communicate

Academic/Cognitive: Difficulty solving problems, learning new concepts, remembering information, or completing age-appropriate task.

Gross Motor: Challenges with big body movements such as; running, jumping, climbing, balance, or coordination.

Fine Motor: Difficulty with hand and finger skills such as; drawing using scissors, buttoning, or manipulating small objects

Behavioral/Social Emotional: Concerns with following routines, managing emotions, interacting with peers, or exhibiting behaviors that interfere with learning.

Medical: Health-related concerns (e.g. seizures, hearing, vision, feeding, or medical conditions) that may impact development.

Other: Any additional concern that is not listed above.

Please describe your concerns about your child's development in as much detail as possible. required

Which agencies are currently involved in your child's care or development?required

Delaware Birth to Three Program- early intervention services for children birth to age 3.

Easter Seals- Therapy, evaluations, or developmental support services.

Nemours Hospital for Children - Medical, developmental, or specialty care.

Division of Family Services (DFS)- Child welfare or family support involvement

Division of the Visually Impaired (DVI)- Services for children with vision needs.

Christiana Care- medical, developmental, or specialty care

Bayada- nursing, therapy, or home health services

None

Other (describe below)

If you answered "other" for the previous question, please describe.

Is your child being treated for any medical needs (such as; seizures, hearing, or vision concerns) or physical impairments that the evaluation team should be aware of? Please explain in detail.required

If you have any existing evaluations, medical reports, therapy reports, or outside assessments, you may upload them here. These documents are helpful but not required to move forward with the Child Find process.

Attach up to 5 files with a maximum size of 10MB

No file chosen

Developmental Screening (Ages & Stages Questionnaire – ASQ)

The Ages and Stages Questionnaire (ASQ) is a brief developmental screening tool completed by parents. It provides valuable information about your child’s development and helps guide next steps.

Completing the ASQ is strongly encouraged, but not required to begin or continue the Child Find process.

Click here to complete the ASQ-3 and/or ASQ:SE

Childcare or Preschool Information (If Applicable)

If your child currently attends a childcare center or preschool, please provide the information below. This helps our team coordinate observations and communicate with the program when appropriate.

Does your child currently enrolled and attending a childcare center or preschool?required

Yes

No

If yes, please confirm the name and address of the childcare center or preschool, along with days and hours of attendance.

If yes, please confirm the name and address of the childcare center or preschool, along with days and hours of attendance. required

I understand that I will be asked to complete a DocuSign authorization allowing the Child Find team to communicate with your child’s childcare or preschool, if needed.

Pre-Registration Documents

The following documents are required to support the Child Find evaluation and registration process.

Child's birth certificate
Parent/guardian photo ID
Proof of address (lease, mortgage statement, or utility bill)
Proof of childcare or preschool enrollment, if applicable (statement from center director)

Please upload PDF copies when available.

If you are unable to upload a document at this time, a team member will follow up with you.

If your proof of residence is not in your name, please contact Stacy.Torrens@bsd.k12.de.us for further assistance.

Child's Birth Certificaterequired

Attach up to 5 files with a maximum size of 10MB

No file chosen

Parent/Guardian Photo IDrequired

Attach up to 5 files with a maximum size of 10MB

No file chosen

Proof of address (lease, mortgage statement, or utility bill)required

Attach up to 1 file with a maximum size of 10MB

No file chosen

Proof of childcare or preschool enrollment, if applicable (statement from center director)

Attach up to 1 file with a maximum size of 10MB

No file chosen

Consent and Scheduling Readiness

This section helps us understand your readiness to move forward with the Child Find process and upcoming steps.

Please review and acknowledge the following statements: required

I understand that my child may be observed in their natural environment.

I understand that my child’s evaluation will take place at the P.S. DuPont Early Childhood Engagement Center, 701 West 34th Street Wilmington, DE 19802

I understand that the eligibility meeting will be conducted via Zoom.

Procedural Safeguards

Families are entitled to certain rights and protections under special education law. Please review the Delaware Procedural Safeguards (English, Spanish, Haitian Creole, Turkish, and Arabic.

Please review and acknowledge the following statement: required

I acknowledge that I have received and have access to the Delaware Procedural Safeguards.

Email Address

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Brandywine School District Child Find Referral

Referral Information

Child's primary residential address:

Child's Primary Medical Provider Information

Parent Input and Developmental Concerns

Childcare or Preschool Information (If Applicable)

Pre-Registration Documents

The following documents are required to support the Child Find evaluation and registration process.

Consent and Scheduling Readiness

Procedural Safeguards