Forms

Authorization Forms

• CIS Authorization Form
  • Instructions for Authorization Form
• Birth to Five Prior Authorization
• Prenatal/Postpartum Prior Authorization

Child Care Financial Assistance Forms

Forms for the Child Care Financial Assistance Program are available on the Vermont Department for Children and Families website. Forms available include the Child with Special Health Need Form and the Family Support Supplemental Forms

• CIS Family Support Child Care Supplimental Intake Form (coming soon)

Additional Forms

• Intake Form
• Family Support Supplemental One Plan
• Insurance Form
• Meeting Notice - English Word version | English PDF version | Arabic Word version | Arabic PDF version | Bengali Word version | Bengali PDF version | French Word version | French PDF version | Nepali Word version | Nepali PDF version | Somali Word version | Somali PDF version | Spanish Word version | Spanish PDF version | Swahili Word version | Swahili PDF version
• One Plan
• Referral Form
• ASQ3 Screening Results Form

Early Intervention Forms

• EI Supplemental Referral Form
• EI Request for Financial Assistance Form
• No One Plan Resulting (NOPR) Form
• Active Form
• Exit Form
• Child Outcomes Summary Form and Decision Tree