Andrew Fleck Child Care Services

Referral Process and Forms

Referral process and forms for parents/guardians.

1. Complete the forms:

NOTE: If there is more than one individual/agency to contact, you will be asked to fill out an Authorization for Release of Information form for each source as we need to send the form with your original signature on it.

To fill out a form, you can download it on your computer and complete it by using Adobe Reader by clicking on the name of the form. Forms are identified with the CISS_Form_Icon.png icon. Once the form has been completed, you can save it or print it and then send it to us via e-mail, mail or fax. Click here to download Adobe Reader for free

2. Send forms to the Intake Coordinator:

Susan Spence - Intake Coordinator,
Children's Inclusion Support Services
700 Industrial Ave., Suite 600
Ottawa, Ontario K1G 0Y9
intake-ciss@afchildrensservices.ca
Fax: 613-736-8378

3. Referral Received

Once the referral is received, acknowledgment of it’s receipt will be provided in writing by the Intake and Resource Coordinator. The signed Authorization for Release of Information form is sent to the individual/agency identified and the following information is mailed to the parents/guardians:

  • letter to acknowledge receipt of the referral
  • CISS Information Sheets
  • CISS pamphlet
  • ACCESS Integration Newsletter Promo
  • library membership form.

The Intake Coordinator will contact you to gather additional information about your child to support future planning when you access a child care program.

4. Determine Eligibility

Upon receipt of the assessment report(s), the Intake Coordinator will proceed to determine the child's eligibility for services.

Once eligibility is determined, a letter will be sent to confirm the child's eligibility. The child's name remains on the referral list and the file is activated when the parents/guardians and/or the child care program informs CISS that a space has been obtained. Depending on the availability of the supports previously identified or the availability of the funding required, the supports will be put in place.

If the child is deemed ineligible, a letter will be sent to the parents/guardians and the child’s file will be closed as of that date.