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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the Parent or Caregiver Name in the designated field. This ensures that the information is correctly attributed.
- Next, fill in the Child’s Name. Make sure to provide the full legal name as this is crucial for identification purposes.
- In the Provider/Covered Entity section, confirm that 'Maryland State Department of Education - Early Childhood Mental Health Project' is displayed correctly.
- Review and complete the Requested Child Information section, including details such as date of birth, gender, race, ethnicity, and any relevant educational plans (IFSP or IEP).
- Sign and date at the bottom of the form to authorize the release of information. Ensure your signature matches your printed name for consistency.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2019 | 4.9 Satisfied (60 Votes) |
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