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Getting Started with CPSE 3-5 Years

CPSE - Committee on Preschool Special Education

Getting your child evaluated through the CPSE (Committee on Preschool Special Education) program has never been simpler with Omni Childhood Center. We guide you step-by-step so the process feels easy and supportive. Fill out the form below and our staff will contact you to begin the CPSE evaluation.

Simple.

OMNI Childhood Center

CPSE Evaluation Referral Form

Fill out the CPSE form below to get started.

CPSE Referral Form

CPSE Evaluation Referral Form 3-5 Years

Guardian Last Name, First Name

I consent to receive evaluation documents via email

Cell

Child's Last Name, MI, First Name

Child's Date of Birth * required

Street Address

City, State, Zipcode

Does your child attend a daycare or preschool?

Yes

What is the school name, address and phone number?

What is the name and phone number of a contact person at school?

Have you tried to get your child evaluated before?

Yes

Did/does your child receive EI services?

Yes

Which services?

ABA/Special Instruction

Speech Therapy

Physical Therapy

Occupational Therapy

Any questions or concerns?

Thank you for submitting!

Star

We'd love to hear from you!
Your feedback is important to us.

Omni Childhood Center provides Early Intervention (0–3), CPSE evaluations (3–5), and SEIT services across New York City, including Brooklyn, Queens, Manhattan, Staten Island, and the Bronx.

Omni Childhood Center

1651 Coney Island Avenue Brooklyn, New York 11230

Tel: 718.998.1415 • Fax: 347.544.2888

info@omnichildhoodcenter.com

Confidentiality Notice: The information submitted here may contain confidential and privileged information for the use of the designated recipients. Review, disclosure, dissemination, distribution or copying of it or its contents is prohibited.

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