APPENDICES FORMS Word Documents EI 5031 ATD Request EI ...
APPENDICES FORMS Word Documents EI 5031 ATD Request EI ...
APPENDICES FORMS Word Documents EI 5031 ATD Request EI ...
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THOMAS R. SUOZZI<br />
COUNTY EXECUTIVE<br />
School District:<br />
Chairperson:<br />
Mailing Address:<br />
Town, Zip Code:<br />
Nassau County<br />
DEPARTMENT OF HEALTH<br />
OFFICE OF CHILDREN WITH SPECIAL NEEDS<br />
Early Intervention Program<br />
Preschool Special Education Program<br />
Physically Handicapped Children’s Program<br />
60 Charles Lindbergh Blvd., Suite 100<br />
Uniondale, NY 11553-3683<br />
ABBY J. GREENBERG, M.D.<br />
ACTING COMMISSIONER<br />
BOARD OF HEALTH<br />
Norma J. Henriksen Chair<br />
Diana Coleman Vice-Chair<br />
Ellen J. Braunstein, M.D.<br />
Donna Kass<br />
SCHOOL DISTRICT REQUEST FOR <strong>EI</strong> PROGRESS REPORTS<br />
In order to assist transition planning please forward the following child’s most recent Progress<br />
Reports to the above address. *<br />
Child’s Name Date of Birth<br />
If you have any questions please call:<br />
/ /<br />
/ /<br />
/ /<br />
/ /<br />
(Name of Contact Person) (Phone Number)<br />
*Progress Reports will be released by the Department of Health only if the Department has already<br />
obtained written parental consent.<br />
<strong>EI</strong> 5294 3/07
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