Preschool Field Officer Program referral

* Indicates required field

Please review details on the Preschool Field Officer Program before completing this form.

This referral form will take approximately 10 minutes to complete, and cannot be saved and completed once the process has begun. It requires prior consultation and authorisation from families before completing.

This form requires the following information:

  • Child’s developmental concerns and how it is affecting their involvement in the program
  • Family consultation around the use of  an interpreter and language required
  • Maternal and Child Health (MCH) and other professional agencies involved
  • Family consent to fill out the form.
Child's details *
Gender *
Early Start Kindergarten
Is the child of Aboriginal descent *
Is the child of Torres Strait Islander descent *
Is the child up to date with Maternal Child Health Checks *
Were any issues raised at the MCH check
Last updated: 3 February 2025 - 11:52am
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