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Early Educational Neglect Referral Form

  1. Referral Form Header

  2. This form is only for reporting 6 or fewer absences. If 7 or more unexcused absences, you must use the maltreatment report form.

  3. To: CP/Intake Unit, Sherburne County Health and Human Services, 13880 Business Center Drive, Elk River, MN 55330

  4. From:

  5. Referral Information

  6. Sex

  7. Does the child have Native American heritage?

  8. This form will be routed electronically to CPMaltreatment@co.sherburne.mn.us

  9. Leave This Blank:

  10. This field is not part of the form submission.