• (715) 852-3600

Early Childhood Request for Assistance

For Preschool Children within the Eau Claire Area School District

In order to complete current requests for screening prior to the end of this school year, requests received after May 1st will not be processed until the start of the next school year. The Eau Claire Area School District is on summer break starting in June.  Staff return to work at the end of August with school resuming in September.  When staff return, your request will be processed in the order that it was received. 

At that time, you will receive follow-up paperwork in the mail.

If you have any questions or are requesting an immediate referral for a special education evaluation during this time, please complete this form and call 715-852-3114.

The first step in this process is gathering information about the child by filling out the form below.  It is essential that you make every effort to provide detailed information in the request form. 

If we do not receive detailed information, an email will direct you to resubmit your request for assistance.

Early Childhood Request for Assistance Form

Child's Gender*:
( ) -
Type of phone:


On weekdays the child is at (check all that apply)*:







Information About the Person Submitting the Request for Assistance

Relationship to child*:








Do parent/guardians give permission for school staff to observe the child in the weekday settings listed above?:

Childcare/Preschool Identifying Information (if applicable)

( ) -

Information about the Child and the Concern(s)

This request is for concerns in the area(s) of (Check All That Apply)*:









Childcare/Teacher/Director/Other Questions

Parent/Guardian Questions

Contact Information for Person Submitting this Request