Child and Student Education Referral Form

Due to COVID 19, all local school districts and Early On programs will be following Wayne County Health Department Guidance and COVID 19 safety protocols.  Face to face or remote supports may be offered in alignment with current guidance.  Please fill out the referral form and be sure to include a phone number and email so you can be contacted by the appropriate staff.  

    Please provide the following contact information

    Please provide a detailed description of child

    For questions call (734) 334-1393.

    This form is intended for children attending Wayne County schools or living in Wayne County ONLY.