ECS - FormsLearning Support :

This page contains forms used for administering the Early Childhood Screening Program. The parent consent, the consent to release information, and the health history form are available in several languages. The Early Childhood Screening Summary form is available from this page.

NEWLY UPDATED! School districts are required to use the new Registration Form for Early Childhood Screening (ED-02390-02) to assign MARSS ID Numbers beginning in school year 2008-2009.

The forms listed below have been developed in partnership with the Minnesota Department of Health and the Minnesota Department of Human Services and are applicable for the Head Start program and the Child & Teen Checkups/EPSDT program.

Early Childhood Screening Consent
Parent consent form for child's participation in Early Childhood Screening (Somali, Vietnamese, Spanish, Hmong, English, Russian).

Early Childhood Screening Health History
Health and Developmental History Form (3-5 years) that meets Early Childhood Screening, Head Start, and Child & Teen Checkups/EPSDT requirements (English, Hmong, Somali, Vietnamese, Russian, Spanish).

Early Childhood Screening Release of Information 
Parent consent form to release information for referrals from Early Childhood Screening (Hmong, Spanish, Somali, Vietnamese, Russian, English).

Registration Form for Early Childhood Screening
Required form (ED-02390-02) for assigning MARSS ID Numbers at the time of screening (English, Arabic, Cambodian, Hmong, Laotian, Oromo, Russian, Serbo-Croatian, Somali, Spanish, Vietnamese).