Referral Forms

Make an online referral for any of our services by completing one of the forms below.

Note: This information is transmitted and stored using secure encryption technology.

Referrals for Parent Infant Program (PIP) Services – Birth to Age 3

See our document: Outline of PIP Referral Process

PIP Services Referral - for CIS-EI

PIP Services Referral - for Audiologists

Note to Diagnosing Audiologists for PIP Referrals:

Send referral directly to CIS-EI (Children’s Integrated Services-Early Intervention).
Simultaneously, send referral and report to Nine East Network for tracking purposes.
In diagnostic report, please document discussion with family of referral to PIP.

Referrals for Pre-K and School-Based Services – Age 3 and Older

PreK-12 DHH Consultant Referral

Sign Language Instruction Referral (Ages 3+)

ASL/Sign Language Evaluation

For more information about any of Nine East Network’s educational services in Vermont, go to Our Services Page.