Eligibility and Referral
For questions regarding eligibility and referral, please contact webreplyspefs@dese.mo.gov.
How to Make a Referral - Call 1-866-583-2392 to be connected to the SPOE in your area, or visit the SPOE Regions Map to see the contact information for the SPOE in your area.
Eligibility/Referral Q&A (removed for revision) (Coming Soon!)
Eligibility and Referral Forms
- Referral Form - (pdf) or (rtf)
- NICU Referral Form - (pdf) or (rtf)
- NICU Referral IC9 Codes - (pdf)
- Combined Enrollment Form and Social History Interview Instructions - (pdf) or (doc)
- Combined Enrollment Form - (pdf) or (doc)
- Social History Interview Form - (pdf) or (rtf)
- Determination of Need for Educational Surrogate Appointment - (pdf) or (doc)
- Early Intervention Record Access Log - (pdf) or (doc)
- Health Summary - (pdf) or (rtf)
- Getting to Know Our Child Worksheet - (pdf) or (rtf)
- Getting to Know Our Child Instructions - (pdf) or (rtf)
- Authorization Form - Evaluation / Assessment / Teaming - (pdf) or (rtf)
- Assessment Reporting Guidelines - (pdf) or (doc)
- Eligibility Criteria - (pdf) or (doc)
- Eligibility Determination Documentation - (pdf) or (doc)
- Eligibility Determination Instructions - (pdf) or (doc)
- Meeting Notification - (pdf) or (doc)
- First Steps Brochure Order Form - (pdf) or (doc)