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

Additional Forms

• Intake Form
• Insurance Form
• 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