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Birth to Five Information Release/Request Form

 

Birth to Five Parent Outreach Banner Logo

Welcome to Tennessee School for the Deaf!

To release or request information, please fill out the form below. 

Thank you!

I hereby give my consent for the Tennessee Schools for the Deaf...*
The purpose of this request is for the provision of early intervention services.*
The purpose of this request is for the provision of consultation and collaboration with the family and child Team Members.*
If the purpose of this request is for the provision of consultation and collaboration with the family and child Team Members, please select all that apply:

Please provide information for all that apply:

Audiologist

Tennessee Early Intervention System (TEIS)

Early Intervention Resource Agency (EIRA)

Local Education Agency

Other

Confirmation Email