Child and Student Education Referral Form Child and Student Education Referral Form

WRESA Online Referral Form



Child / Student Referral Information


Child / Student Name


Child / Student Address

We cannot use P.O. Box numbers


Child / Student Birthday


Child / Student Gender and Ethnicity


Birth Details



Child / Student Developmental Concerns



Parent / Guardian Information

Parent Address Information



Referral Contact Information

For questions call (734) 334-1393. This form is intended for children attending Wayne County schools or living in Wayne County ONLY.

You should receive an email confirmation within two business days from