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Early Stages is currently scheduling in-person evaluation appointments for all families. Find our most updated operating status here

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Early Stages Referral Form

Anyone may refer a child between the ages of 2 years 8 months and 5 years 10 months for a screening. The special education evaluation process will only begin after a parent/ guardian has provided written consent.  

To refer a child to Early Stages,  

  • Fill out the online form below (strongly preferred),  
  • Email a completed referral form[PDF] to  [email protected]
  • Call us at (202) 698-8037, 
  • Or fax a completed  referral form[PDF] to (202) 654-6079. 

 

Child Information
(First Name, Last Name)
Format: mm/dd/yyyy
Check any that apply
Check one
Check any that apply
(First Name, Last Name)
Please enter the phone number in this format 202-555-5555
Please enter the phone number in this format 202-555-5555
Select all options that apply.
Referrer Information (please complete if you are not the parent of the child being referred).
(First Name, Last Name)
Please enter the phone number in this format 202-555-5555
Please enter the phone number in this format 202-555-5555
Additional Information (please complete if known).
(First Name, Last Name)
Please enter the phone number in this format 202-555-5555
(First Name, Last Name)