FDLRS Island Coast Child Find Referral

Child Find Referral

FDLRS Island Coast Associate Center Serving Collier and Lee Counties
If the child you are referring is under 2 years, 10 months old, please contact: https://hpcswf.com/programs/early-steps/early-steps-program

If the child you are referring is over 6 years old, please contact Renae Seguin, Parent and Family Services Specialist, at renaekl@leeschools.net or 239-337-8539.

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Step 1: Fill out the referral below.

Step 2: Once a PARENT completes the referral, a new green form will appear that you must complete and submit. (If you are not the parent, you only need to submit the referral).
Name of Child*

First NameLast Name
Child's Date of Birth*
MM/DD/YYY
YesNo
YesNo
Name of Person Completing This Form*

First NameLast Name
Email of Person Making Referral*
example@example.com
Relationship to Child
Phone Number of Person Making Referral
Please enter a valid phone number.Format: (000) 000-0000.
Collier CountyLee County
YesNoI don't know
YesNo
Avalon ElementaryBear Creek ElementaryCalusa Park ElementaryCorkscrew ElementaryEden Park ElementaryEverglades City SchoolFun Time Academy Head StartGolden Gate ElementaryGolden Terrace ElementaryLake Trafford ElementaryLely ElementaryManatee ElementaryMike Davis ElementaryNaples Park ElementaryOsceola ElementaryPalmetto ElementaryParkside ElementaryPelican Marsh ElementaryPinecrest ElementaryPoinciana ElementarySabal Palm ElementaryShadowlawn ElementaryVineyards ElementaryVillage Oaks ElementaryAutism Collier Charter SchoolBridgePrep Academy of CollierGulf Coast Charter Academy SouthInnovation Preparatory Academy of NaplesMason Classical AcademyNaples Classical AcademyOptima Classical Academy
Allen Park ElementaryAmanecer ElementaryBonita Springs ElementaryCaloosa ElementaryCape ElementaryColonial ElementaryDiplomat ElementaryDr. Carrie D. Robinson Littleton ElementaryEdgewood AcademyEdison Park Creative and Expressive Arts SchoolFort Myers Beach ElementaryFranklin Park ElementaryG. Weaver Hipps ElementaryGateway ElementaryGulf ElementaryHancock Creek ElementaryHarns Marsh ElementaryHector A. Cafferata Jr. ElementaryHeights ElementaryJ. Colin English ElementaryJames Stephens ElementaryLehigh ElementaryManatee ElementaryMirror Lakes ElementaryOrange River ElementaryOrangewood ElementaryPatriot ElementaryPelican ElementaryPine Island ElementaryPinewoods ElementaryRay V. Pottorf ElementaryRayma C. Page ElementaryRiver Hall ElementarySan Carlos Park ElementarySkyline ElementarySpring Creek ElementarySunshine ElementaryTanglewood ElementaryThree Oaks ElementaryTice ElementaryTortuga Preserve ElementaryTrafalgar ElementaryTreeline ElementaryTropic Isles ElementaryVillas ElementaryCapstone Charter AcademyBonita Springs Charter SchoolGateway Charter SchoolHeritage Charter AcademyMid Cape Global AcademyOak Creek Charter School of Bonita SpringsOasis Charter-NorthOasis Charter-SouthInnovation Preparatory Academy of South Fort MyersThe Island School
Child's Gender*
Child's Race*
Child's Ethnicity*
Languages Spoken in the Home*
Mother or Legal Guardian Name*

First NameLast Name
Father or Legal Guardian Name*

First NameLast Name
Both ParentsMotherFatherOther
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email*
example@example.com
Reason for Referral (Areas of Concern)*

0/100
YesNo
If Yes, name of current daycare, preschool or school
Important Medical History or Diagnosis?
Is your child receiving any private therapy services? If so, where and how often?
Should be Empty: