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* 1. Your Name

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* 2. Email Address

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* 4. True of False - Schools and other primary referral sources are responsible for coordinating public outreach activities with the regional CIS/EI programs.

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* 5. True or False: The regional CIS/EI program is the single point of contact to receive referrals for children from birth up to three years of age who may be eligible for early intervention services. 

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* 6. Scenario - At one of the WIC clinics, Ava's mom says she is worried that Ava (an 18 month old girl) is not talking as much as her older brother Ben did when he was the same age.  The WIC nurse asked if she has talked to her doctor about this concern.  She has not. 

True or False: The WIC nurse must get written consent first from Ava's mom in order to send a referral to the regional CIS/EI program.

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* 7. Select best response to complete the sentence. 

Hospitals, physicians, schools and other primary referral sources shall refer a child to the regional CIS/EI program as soon as possible and no more than ____ days after identification. 

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* 8. Please select the best response. Public awareness for Part C means:  

T