EI/ECSE Forms EI Eligibility (Birth - 3)

New School Age Forms Updates for SB 13 &16

All forms are in word format

All forms are in word format

• Statement of Eligibility - Developmental Delay EI (B-3) 581-5149C-X
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
  • Vietnamese Language Version
• Statement of Eligibility - Physical or Mental Condition EI (B-3) (Cross-referenced under Medical Statements) 581-5150d-P
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
  • Vietnamese Language Version
• Statement of Eligibility - Visual Impairment EI (B-3) 581-5148E-X2
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
  • Vietnamese Language Version
• Statement of Eligibility - Deaf or Hard of Hearing EI (B-3) 581-5148F-X2
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
  • Vietnamese Language Version
• Statement of Eligibility - Orthopedic Impairment EI (B-3) 581-5148H-X2
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
  • Vietnamese Language Version
• Statement of Eligibility - Autism Spectrum Disorder EI (B-3) 581-5148L-X2
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
  • Vietnamese Language Version
• Statement of Eligibility - Deafblindness EI (B-3) 581-5148M-X2
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
  • Vietnamese Language Version
• Statement of Eligibility - Traumatic Brain Injury EI (B-3) 581-1439-P
  • English Language Version
  • Chinese Language Version
  • Russian Language Version
  • Spanish Language Version
    
  • Vietnamese Language Version