Provider Connections
Documents
- EI Provider Handbook (Revised 12/16)
- Credential Extension Request Form
- Justification to Change Frequency, Intensity, or Location
- Updated List of Assessment Tools
- Request for Duplicate Documents
- Child and Family Connections (CFC) Procedural Manual
- Evaluator Report Format
- Consultation Vertification Form
- Ongoing Professional Development Documentation Plan and Format
- Standardized Illinois Early Intervention Referral Form
- Illinois Early Intervention Program Referral Fax Back Form
Report Formats
- Discharge Report Format
- Evaluation/Assessment Report Format
- Six-Month Review Report Format
- Medical Diagnostic Report Format
- EI Provider Developmental Justification to Change Frequency, Intensity, and/or Location of Authorized Services Worksheet
- Natural Environments Justification Worksheet
NOTE: Please refer to Handbook for guidance on use of formats.
Contact Info
Provider Connections
Center for Best Practices in Early Childhood Education
Western Illinois University
1 University Circle
Macomb, IL 61455
Phone: 800-701-0995
Fax: 309-298-3066
Email:
providerconnections@wiu.edu
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